>
>
>Date:    Fri, 5 Sep 2003 18:49:44 EDT
>From:    "Chris Smith, RN, IBCLC" <[log in to unmask]>
>Subject: Reimbursement
>
>I work for a children's hospital and we have been charging for our services.
>Because of  lack of staffing, we only see inpatients, with a concentration in
>the NICU. I have recently been asked by my manager ( I am under Clinical
>Nutrition) what my productivity level was. According to her, ADA says that RDs
>should be billing for 60% of their time worked and she wanted to know what the
>standard was for lactation consultants. I called ILCA and IBCLE and neither knew
>of this standard for our profession. I wondered how many of you bill for
>inpatient serviced and if anyone has any idea about what percentage of my time
>worked should be billable. I tried to explain to her that none of her dieticians
>do statistics for their programs, teach NICU orientation for the nurses, meet
>and interface with many other disiplines, etc. She didn't have an answer for
>that. She is getting pressure from her manager to justify time worked. Does
>anyone have any insight into this that I can take to her next week?
>Thanks,
>Chris Smith, RN, IBCLC
>
I have to disagree with Chris about the role of dietitians.  I know for
a fact that there are dietitians in your position in many other
hospitals across the country, doing *exactly* what you do.  We just
don't get paid as well for it because you can bill as a nurse.  So if
they would want to cut costs, it usually begins in the Clinical
Nutrition department.  I have spoken to many IBCLCs, and they feel that
it would be a breeze for me to get my IBCLC, except for getting the
clinical hours part in this rural area.  But that's a minor hurdle for
me.  I have no idea what the percentage of my billing for time worked
is, but I'm sure that it wouldn't be much.  I work in public health,
developmental evaluation, infant/toddler as a medical nutrition
therapist.  When those stats are compiled by the State I work for, they
vary *widely* from area to area.  I really wish more of my mom's would
even consider breastfeeding, it's one of my assessment questions,
although many pump while the baby's in the NICU.  Many have been
disappointed that I wasn't referred to them sooner to help with
nursing/nurishing their newborns.  The system is convoluted at present,
but will be better mainstreamed over the next year.
Wish me luck!
Diana M. Miller, MPH, RD
rural NC USA

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