Procedure Reimbursement

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NinerNiner999

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So i'm chillin here in the ICU and have finished a day with 12 procedures - an LP a couple of central lines, a few A-lines, etc. How much would a typical procedure like those above cost a department to actually perform (materials, etc), and how much do ED's charge for those procedures.

What is the reimbursement for typical procedures and how is it factored into our pay? Is it incorporated into our hourly rate based on average or do we get additional procedure "bonuses?" Do we get a combination of both? I'm just curious. A nurse informed me that the charge for Swan monitoring is around $3-4000 :eek: . If that's the case, I just had a super bonus day!

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I know our LP trays only actually cost us about $8, but we bill $120 or something like that.
 
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Don't forget most hospitals charge for all the materials used on the patient unless they have specific arrangements with the payer for a flat amount for each procedure. So if you go through 6 line kits trying to get the line in they will document and bill for it. The procedure itself is a seperate charge by the physician doing or in your case supervising the procedure. Procedures can be good money in the ED. Many of the procedures we do pay more than a level 5 visit. Unfortunately, as an intern none of this money will go to you and since you are at an academic center with a big indigent population most of it isn't even collected. When my wife worked at Sinai in NYC she got an annual report of what was billed in her name and what was collected. They did a terrrible job of billing for everything she did and collected less than 10% of that.
 
ERMudPhud said:
They did a terrrible job of billing for everything she did and collected less than 10% of that.

You're not kidding - I was seen in the Elmhurst ED. I had Mt. Sinai health insurance. I brought my card. They sent me a bill later for physician's service. I sent the data in again. They sent me another bill. I called them and said to pull up the record, because I don't have the card anymore (I was already at Duke). They sent me another bill. They didn't get paid.

I don't know what to say when the group doesn't collect on someone who has insurance - that's like gold.

When I do procedures in our ED, there's a place on WellSoft to put it in, and most have the charge. I always say, "There's $106 (or whatever) that I won't be getting" (although still gratifying, nonetheless).
 
Apollyon said:
You're not kidding - I was seen in the Elmhurst ED. I had Mt. Sinai health insurance. I brought my card. They sent me a bill later for physician's service. I sent the data in again. They sent me another bill. I called them and said to pull up the record, because I don't have the card anymore (I was already at Duke). They sent me another bill. They didn't get paid.

Dude:

I can't believe after all the hard work to disguise your true identity you just gave it all away with the "I was already at Duke". Arrrggghhh.

What's worse, when you work for a large contract group and they bill for your procedures and then KEEP the revenue for themselves, now that's frustrating!!
 
We go up and intubate pts on the floors and I've been told that's worth a few hundred bucks. We bill for all of our procedures. One thing to keep in mind for all you seniors and attendings is that you can't include the time to do separately billable procedures in critical care time. For instance if a pt comes in and in 30 min you've intubated, central lined and admitted your patient you can't bill for CC time.
 
docB said:
We go up and intubate pts on the floors and I've been told that's worth a few hundred bucks. We bill for all of our procedures. One thing to keep in mind for all you seniors and attendings is that you can't include the time to do separately billable procedures in critical care time. For instance if a pt comes in and in 30 min you've intubated, central lined and admitted your patient you can't bill for CC time.

The way I look at it though even the sickest patient is in the ED at least an hour. I can do every procedure I'm going to need to do in less than half an hour. You can count time talking to consultants, PCP's, family, and reviewing old records as critical care time (or so I've been told) and I figure I have at least half an hour of that on any seriously ill patient.
 
ERMudPhud said:
The way I look at it though even the sickest patient is in the ED at least an hour. I can do every procedure I'm going to need to do in less than half an hour. You can count time talking to consultants, PCP's, family, and reviewing old records as critical care time (or so I've been told) and I figure I have at least half an hour of that on any seriously ill patient.

I agree with you but if the presentation time is 2000 and your admit orders say 2030 and you did some seperately billable procedures you better not bill CCT. My billing company would toss that to avoid getting us in trouble. This is of course a semi hypothetical case because it's rare to dispo a critical pt in 30 min.
 
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