Claudia Gumina

June 20
th
, 2014
Clinical Homework

Billing Assignment

During my billing assignment discussion at Concord Hospital, inpatient
billing was not discussed thoroughly as it gets billed as part of the big cost. The
inpatient dietitians do not get paid per patient, but by the hour on a pre-established
salary. Malnutrition orders, which need to be signed by physicians, help build up the
cost of a patients stay, but it does not in any way increase the reimbursement to
nutrition services.
When it comes to outpatient billing, how much gets reimbursed depends on
the insurance the patient has. Medicare, for example, only allows nutrition consults
for patients with diabetes or renal failure, and only a certain amount of hours a year.
Based on the type of consult, a number is coded which stands for the services
offered. This then goes to the hospitals billing-accounting department, who then
takes over and communicates with the different insurance companies for
reimbursement. The program director needs to be familiar with all the different
codes and insurance preference in order to get their services covered. If a service is
not covered, they have to give the patients an advance notice of known coverage in
which they inform the patient that their consult is not covered and they will have to
pay for it themselves. For patients who have gone over their allotted hours, there
are different MNT hours which can be billed to insurance with a new doctors orders
stating the patient requires additional nutrition counseling. In facilities with CDEs,
reimbursement is higher since they can do many other things that others cannot like
pump installations and adjustments. Depending on the patient, they may also get a
new glucose meter and this is also covered under their insurance. Overall,
reimbursement will happen if the coding is done correctly, which is why
understanding the process is key.