Replies for peers. Need ONE Response Per Each Discussion Total 2 Responses. Attached Are The Discussions And Rubric Please Follow Them. Posts Will Be A Minimum Of 100 Words, APA Format.One Reference Per Each Discussion

Alexie Guzman (classmate’s response)

Research how your facility bills for nursing services. For many years, it was bundled with the room charge (along with housekeeping). What is the process today? If it a true reflection of nursing’s value?

I currently work in primary care as a case manager, I have a panel of patients that are assigned to me to manage their daily care. I see patients by nurse appointments or what we call walk ins, since theses patients are seen by me or other nursing staff, we must close the encounter that visit has created. Theses encounters must be closed before the end of each fiscal year, in these encounters we include services we provide as nurses, example vital signs, compact cerumen removal, ekg by using ICD-10 billing codes. In my opinion this is a true reflection of nurse valve, the organization having the opportunity to bill medical insurance that their staff nurse provided. According to (Cheng et al., 2021) In 2015, the United States transitioned from ICD-9 to ICD-10, requiring the VA-FI to be updated for contemporary use. Although the Centers for Medicare and Medicaid Services (CMS) provide general equivalence mappings (GEMs) to assist with conversion to ICD-10.

The services for other departments as PT, OT, Rehab are billed in the same manner, using encounter for services provided by their staff, pharmacy department bill by medications provided to each patient, if patient is 50 percent services connected patients received free medication, if they are not they have a co-pay that is billed by the VHA system.

Reference

Cheng, D., DuMontier, C., Yildirim, C., Charest, B., Hawley, C. E., Zhuo, M., Paik, J. M., Yaksic, E., Gaziano, J., Do, N., Brophy, M., Cho, K., Kim, D. H., Driver, J. A., Fillmore, N. R., & Orkaby, A. R. (2021). Updating and validating the u.s. veterans affairs frailty index: Transitioning from icd-9 to icd-10. The Journals of Gerontology: Series A, 76(7), 1318–1325. https://doi.org/10.1093/gerona/glab071

Leezbeth’s (classmate response)

Health care is expensive and becoming increasingly more so. Nurses are an important part of the health care economy, and charges in health care financing impact on nurses and nursing care (Penner, 2017). Nurses are an anomaly in the current inpatient billing system. Rather than bill for the actual services provided to the patient or the amount of time spent providing nursing care, the cost of nursing is embedded into the line item for room and board, which is the same fixed cost for every patient receiving the same level of care within a particular institution. In other words, all patients cared for on a given unit are billed the same room and board charge regardless of the actual amount of nursing care the patient utilized during that hospitalization (Lasater, 2017). The services billed for nurses, is not a true reflection of the value of nursing. Nurses are special individuals who ultimately want to care for and help others as much as they can. I strongly believe the values and qualities of a nurse cannot be billed. The amount of work that is done by a nurse cannot truly be captured. Some of the services that are priceless include caring, compassion, dependability, empathy, focusing on the patient defining quality of life, providing holistic patient centered care, and respect.

I had surgery over a year ago and still continue to receive EOBs, so I pulled them out to see exactly how everything was billed.  Pharmacy/general is billed independently, as well as all the meds I received are billed individually. Physical therapy/general billed for each day they saw me. My inpatient stay/general is billed which would include my nursing care as well.

References

Lasater, Karen B. 2017. “Invisible Economics of Nursing: Analysis of a Hospital Bill through a Foucauldian Perspective.” Nursing Philosophy 15 (3): 221–24. doi:10.1111/nup.12040.

Penner, S. J. (2017). Economics and financial management for nurses and nurse leaders (3rd ed.). Springer Publishing Company.