re-imbursement coding questions

  1. I work in a small hospital in rural Ohio, and a friend of mine, working in another area of the hospital has a question. She like many are fighting with new codes and ways to get reimbursements for the services we provide.
    I want to stress right now, I do not understand what is actually going on!
    I think that is the problem, neither do they exactly. From what she tells me, they are not getting the money we could be getting, and one "offcial source" tells them one thing, someone else, something else.
    Anyone out there think they may be able to help my friend?? Feel free to either respond here, or PM me, and I'll get my friend involved.
    Then I'll disappear!! :chuckle
  2. Visit mcmike55 profile page

    About mcmike55, BSN

    Joined: Jan '04; Posts: 428; Likes: 95
    Surgical RN
    Specialty: 40 year(s) of experience in surgical, emergency


  3. by   P_RN
    reimbursement from.....?
    Codes for what?
    Is your friend in accounting? a nurse?
  4. by   mcmike55
    Sorry, I said I wasn't really in my element with this subject!!!
    She was talking about coding diagnosis vs treatments and tests that were being done in our hospital. I believe we are talking about Medicare, Medicaid and health insurance 3rd party payers.
    For an example, my friend, an LPN who now does chart reviews, said that we were not getting paid for Albuterol inhalers for ER pt's because they were, and I am not sure of the term exactly, a medication that a pt could use at home, and not only in the hospital.
    In the OR where I work, one of our nurses has been working very closely with accounting people upstairs to re organize our charges because we were not getting what we should.
    Hope that helps. I am trying to talk my friend into becomming a member so she can work on this issue here.
  5. by   alintanurse
    in response to your question re: reimbursement of meds--your billing dept. should be able to get a formulary list from the particular insurances also the pharmacist is usually very helpful as far as knowing what meds are paid for and which are not. For example medicaid will not cover certain antibiotics but will cover must then ask the treating MD to choose from that list if the med 's actions are similar. also if the code you are talking about is the ICD code it needs to match.
    Last edit by alintanurse on Jan 1, '05
  6. by   renerian
    From the home care venue aspect I know that people were having trouble getting the new codes to be accepted as they were not loaded into the OASIS system/so I heard upon making many calls.

    I don't know if this is a similar issue or not.