Bedside Procedures: What's Included in the Room Rate

by Denise Williams, RN, COC

A common concern for hospital providers is that if they charge a bedside procedure for an inpatient, they are “double dipping”—that is, they are charging twice because everything is included in the room rate. But does anyone really know what items and services are included in the current room rate? Or is it assumed that “it has always been that way so it must be true”?

Routine services

First, we must determine exactly what is included in the room rate. Providers’ and payers’ traditional stance is that, for an inpatient, everything is included in the room rate. But is that in fact the case?

Does anyone really know what was included when the room rate was first determined? Times have changed, and the industry needs to revisit this assumption. There are specific reasons for reconsideration:

1. Does a provider really know, and can they support with documentation, what services and items are really accounted for in the room charge? Who participated in the initial decision-making process? Is that information documented anywhere?
2. Are all of the services currently provided to inpatients truly included in the cost and in turn included in the charge for the room rate? There have been so many medical advances and new technology introduced to the industry that the room rate might no longer be adequate or accurate for all of the possible services.
3. Are there services that should be reported separately for cost and data purposes rather than being automatically included in the room rate?

The next step is to determine what services should be included in the room rate. “Basic and routine” nursing services should be included, but consider what “basic” and “routine” mean. The definition of “routine services” will vary between different areas in the hospital—for instance, what is “routine” in the surgical suite will be different from what is “routine” on a medical surgical unit, which will be different from what is “routine” in an intensive care unit.

CMS weighs in on this subject in the Provider Reimbursement Manual, defining routine services as including “the regular room, dietary and nursing services, minor medical and surgical supplies, medical social services, psychiatric social services and the use of certain equipment and facilities for which a separate charge is not customarily made.” Let’s consider each of these points separately.

Regular room, dietary, and nursing services

Consider the items and services that are provided to every patient. Regardless of where in the hospital a patient is treated, services such as electricity, water, heat, air conditioning, housekeeping, trash/biohazard disposal, changing linens, and administrative services are all routinely provided to every patient regardless of inpatient or outpatient status. These items are not always considered services, but without them, the facility can accomplish nothing.

Minor medical and surgical supplies

Supply items to consider for this category include those that are kept in “bulk supply,” available for use with every patient and not easily traced to a single patient. Items on this list include, but are not limited to, alcohol prep pads, betadine swabs, mouth care swabs, linen savers or “chux,” and simple adhesive bandages (e.g., Band-Aid®). Nurses can remove these items from the supply and use them on any patient at any given time without a specific physician order. They are rarely individually documented. Compare these to items that are “stored on the shelf” for easy access by nursing staff, such as Foley catheter trays and IV fluids. They are kept in “bulk supply,” but their use requires a specific physician’s order for a specific reason and specific documentation of the performance of the procedure, creating a clear record of which patient the item was used for.

Medical social services and psychiatric social services

Services related to coordinating transfer to another facility, transfer to a post-acute care facility, home health services, and discharge planning are not separately reported because they are standard services available to all patients and provided based on individual patient needs.

To view the complete, detailed article that appeared on Medicare Compliance Watch, click here.