Recently our Charge Capture Dept has said that we are no longer charging for PICCs inserted by nurses. They say it is absorbed in the DRG and therefore not a billable charge. This is a county hospital where the vast majority of patients are self-pay or MC/MA. Is this right? How can we move forward with the development of our team if we have no revenue (billed charges) to support our efforts? My budget shows thousands of dollars of expenses but nothing for revenue or billed procedures. Is this common practice?
Yes, it is correct. Under any capitated fee structure such as the DRGs from Medicare , the hospital receives a flat fee based on the diagnosis of the patient. This fee will not increase based on the procedures you perform. Your job is to use PICCs in a cost effective manner so that the total cost of vascular access consumes a smaller portion of that DRG, not so that you can bill for this procedure. Most hospitals still do some type of patient charge so that a percentage of that DRG can get allocated to your budget for the services you provided. But it is a fact that the amount of money paid to your hospital by Medicare will not increase with PICC insertion into these patients.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Gail McCarter, BSN,CRNI
Franklin, NH
For those of you who work at small critical access hospitals, we are not reimbursed by DRG for Medicare patients, so we continue to charge each successful insertion. For all the rest of you reimbursed by DRG, outpatient rules are sometimes different than inpatient and you may be able to charge for reimbursement there.
Gail McCarter, BSN,CRNI
Franklin, NH
yes this is true, however, you have to remember as Lynn says that our job is to obtain access early in the admission so that the hospital doesn't consume so much of the DRG in obtaining peripheral IV access. Also, are you doing any outpatient picc placements, there is opportunity for you to get some revenue there. A few other things, showing your hospital that you save money by decreasing LOS by having adequate IV access hence not missing important medications; the operational cost of a bedside picc team (approx $300 per line) vs the operational cost of an IR placed picc line (approx $1000 per line) = $700 operational cost savings per line as well as allowing IR the extra hour not required to place the picc line to do some revenue producing procedures. Also, when MC/MA does your facility review each year for DRG reimbursement, if you are not entering charges for everything you do, how will you expect them to increase your reimbursement any? Just a thought.