Third-party payor billing and reimbursement for nursing services: infant apnea management.
This article examines the process of implementing a program for billing third-party payors for the services of the pediatric clinical nurse specialist. Factors to consider when initiating a billing program are discussed, as well as guidelines for structuring the charges, obstacles to reimbursement and strategies to overcome them, and benefits (both direct and indirect) of implementing such a program. Examples are cited from apnea management programs at two major children's hospitals in the southwestern United States. Implications are made regarding generalizing these methods to other nursing services and practices.
Herda
J A
JA
Pediatric Pulmonology/Apnea Electrodiagnostic Center, Children's Hospital of Orange County, CA.
Perry
D L
DL
D001049:Apnea / Q000191:economics / Q000451:nursing*; D001130:Arizona; D002648:Child; D003362:Cost-Benefit Analysis; D005249:Fees and Charges; D017048:Health Care Costs; D006776:Hospitals, Pediatric / Q000191:economics; D006801:Humans; D007355:Insurance, Nursing Services; D009720:Nurse Clinicians / Q000191:economics*; D009738:Nursing Service, Hospital / Q000191:economics*; D010350:Patient Credit and Collection / Q000458:organization & administration; D010371:Pediatric Nursing / Q000191:economics*; D012051:Reimbursement Mechanisms