Q&A: Separate Reporting Versus Inclusion in the Room Rate

May 17, 2016
Medicare Web

Q: How should hospitals report bedside procedures?

A: Without a doubt, this is an Olympic-level exercise, and it is not going to be decided or implemented overnight. Each facility must carefully consider why and how to separately report bedside procedures and will make an individual decision about whether to do so or not. This process should be multidisciplinary, with representation from revenue integrity, cost accounting, chargemaster, the finance department, third-party payer contracting, billing and coding departments, all affected clinical departments, and those responsible for charge capture or charge entry. Note that this major strategic decision must be aligned with other pricing and patient experience strategies. Why should a facility even consider making this change? Here are some possible reasons:

  • Improved cost data captured related to individual patients; consider the impact of improved data on accountable care organizations and bundled payments
  • “Credit” for services provided by nursing staff
  • More specificity for contract negotiations with individual payers
  • More specific cost information available to make informed operational decisions and to have open and honest discussions with individual physicians and NPPs based on the cost of their specific activities
  • Assurance of consistency in charging across all patients
  • Improved structure and consistency for charge capture processes
  • Increased transparency as data reflecting cost of services becomes more apparent
  • Improved inpatient reimbursement rates in the future, including DRG reimbursement

For more information, see the Billing for Ancillary Bedside Procedures Training Handbook.

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