Dear Pam,
I was wondering about outpatient fee reimbursement... Are you reimbursed through Medicaid? Can you explain how your facility withholds fees from those without ability to pay, yet charges insurance companies and is not risking insurance fraud? This aspect of the practice is still quite new to me.
Our institution has determined since Medicaid won't pay, we aren't going to charge. I would love to demonstrate that lactation is a cost-effective service, yet we are predominately all Medicaid and/or low-income. I am not clear why we can't charge as a nurse visit either way.
Thoughts?
Penny Lane
"Pam Hirsch, RN, BSN, IBCLC" <[log in to unmask]> wrote:
Brenda: We bill outpatients - now, if I only had space to see the moms...but
that's another issue. We really don't do any advertising. It's mostly word of
mouth or a mom just shows up wanting to be seen. The hospital I work in is
part of a large corporation. I contacted our corporate people a couple of
years ago about the feasibility of billing both inpatients and outpatients. I was
given billing numbers and a fee structure - our fees are based on time. We bill
$53 for a Level I visit of 20 minutes or less, $105 for a Level II visit of 20-45
minutes, and $210 for a Level III visit which is anything over 45 minutes. We
all know how long a visit that involves a feeding is. Most of our visits are
Level III billings, and do include any equipment except pump kits. We
currently do not rent pumps or do any kind of retail business. One of our
techs does my billing for me. She is also kind enough to do the billing after the
visit. All she asks is that I make a copy of the mom's driver's license and her
insurance card, write down the visit level and make sure there is a doctor's
order in the chart. I work under a standing order, which saves the mom from
having to stop at the doctor's office and get a prescription and saves the
office staff from having to fax an order over to me. This saves mom from
having to sit in outpatient admitting for who knows how long with a screaming,
hungry baby. She can come right up to my office. I very rarely have a mom
tell me that her insurance would not cover a LC visit - I tell them when I set
up her appointment to check with her insurance. For any mom who will not be
covered by insurance, the visit is free.
I almost had Corporate convinced that we should also bill for inpatient
lactation visits, but then they decided that LC visits were part of the nurses'
education at the bedside and wouldn't allow it. We are looking into billing in a
situation where mom has been discharged, but is seeing Lactation when she
comes in to see her SCN baby. I can some days spend quite a bit of time with
what is technically an outpatient SCN mom and we are not considering these
billable visits.
Hope this helps.
Pam Hirsch, BSN,RN,IBCLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL USA
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Penny Lane RN, IBCLC
Maternal & Child Health: Lactation Consulting
Believe - Birth & Breastfeeding Resources
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