Catherine: One of the advantages of being hospital-based is the ability to
utilize all the different departments. Meet with your billing people and
tell them that you want to bill outpatients for lactation services. This
is not your responsibility - there is an entire department of people in
your hospital who get paid by the hospital to bill patients. You get paid
(I hope) to provide lactation services to patients. It took me over a year
(partly because I have to work thru a corporation as well as my individual
hospital) to get our billing system in place. I have a wonderful tech up
here on the unit (one of her responsibilities is to do all our ordering)
who has graciously offered to put the billing thru so that the poor mother
does not have to sit in outpatient admitting with a screaming, hungry baby
to get put into the system. Mom calls me, we set up an appointment, she
comes directly to the unit, I get a copy of her driver's license and
insurance care, write down the visit Level (we have a 3-tiered system based
on amount of time spent with mom), write the doctor's order (either verbal
or standing), and hand the chart to our tech. She does the billing and
hands the chart back to me. Done! It's about as painless as I could make
it. The vast majority of our patients are insured. I do not bill Medicaid
patients - the hospital just eats the cost, as there are so few. As we
increase our Medicaid population that may have to change, but I'll worry
about that when the time comes.
I was given approval just last week to bill mothers who have been
discharged but still have a hospitalized baby for the visit I do with them
in the SCN. If the mother, nurse, or doctor requests lactation, that is a
billable visit. As we revise our nursery standing orders, we will put a
standing order for lactation on the SCN orders. Our neos do not have any
problem with writing an order for lactation right now. A standing order is
already on the regular nursery and post-partum orders. Our tech pulls the
baby's face sheet from the chart to get mom's medical record number, and
puts the billing thru. The only inconvenient part of the process is that
the hospital requires a signed consent for healthcare for each visit from
the mother.
So, work with the experts you have at your fingertips to get this done.
After all, how many doctors do you know who know how their office/practice
is actually run?
Speaking of doctors, our unit right now feels like a cardiac unit, as we
have several mothers with issues (duh, fluid overload, maybe?). One of
these moms (premie twins in SCN) is on 3 antihypertensives, an anti-
coagulant, and a diuretic and was told by a cardiologist that she could
absolutely not pump/nurse because she "is on too many medications"! She
was quite upset when I saw her. I sat with her nurse and looked everyting
up in Hale (all are OK). When I spoke with another cardiologist from the
practice who came to see her yesterday, he told me he told the mom he
didn't know and would ask me! I think he was looking for more business as
he is one of my cardiologists and knew he would cause me to have
palpitations or a heart block by saying that to a patient. He is good
though, in that he actually listens to the patient or the nurse!
Sorry for the length!
Pam Hirsch, BSN,RN,IBCLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL USA
Feel free to contact me off-list, Catherine, if you want to discuss further.
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