Reporting and charging for bedside procedures improves healthcare data and transparency

It’s increasingly critical to provider survival to report services accurately as the healthcare industry continues to move toward improved data mining and cost transparency. Providers are generally reimbursed based on the cost of the services they provide to patients, regardless of whether the payment itself is based on diagnosis-related group (DRG), ambulatory payment classification (APC), per diem, or percent of charges. The charges submitted to payers are based upon the cost of providing the service, including the costs of electricity, water, building maintenance, salaries, and other facility and operational costs. These items are part of the cost of providing patient care services.

For providers to report the cost of providing care, there must be some specificity to the way that services are reported. If “everything” for an inpatient is included in the daily room rate charge, how will the provider or payer know what it really cost to care for an individual? In that case, the only defining component is the number of room rates (days) reported to the payer, and both parties lose the individual cost per patient. For example, Patient A might have required more procedures than Patient B, but the individual cost of care is lost because Patient A stayed the same number of days as Patient B.

The cost of resources used in providing bedside procedures is no less important than the cost of resources to perform the same procedures in a hospital department, even though the resources may be different (nursing vs. a radiology technician).

Reporting bedside procedures as a separate line item is one way to differentiate the individual cost of care for each patient. If all bedside procedures are considered to be included in a room rate, then the granularity of cost for the specific patient is lost. In that case, the claims data imply that all bedside procedures carry the same resource cost and allocation, regardless of the individual procedure. Because these same procedures are reported individually on an outpatient basis, the industry knows that assumption to be false.

This originally appeared in Billing for Ancillary Bedside Procedures.