The infusion nurse's role in precertification.
Gibbs Regional Cancer Center, a comprehensive cancer center, is part of the Spartanburg Regional Medical Center located in Spartanburg, South Carolina. Palmetto Hematology Oncology PC, located within the Gibbs Regional Cancer Center, is a private practice infusion therapy center owned by six physicians serving upstate Carolina residents. The practice has been successful in using precertification to confront complex reimbursement issues, complicated treatment methods, and demanding practice measures to ensure quality cancer care for patients. In the past 18 months, Medicare reimbursement guidelines for medications offered to patients at nonhospital infusion outpatient centers have been cut, and the future reimbursement criteria are uncertain. These cutbacks have caused other infusion centers to close or change practice guidelines. Precertification at Palmetto Hematology Oncology PC has trimmed treatment losses, increasing the focus on patients. Precertification of patients is not a new idea, but a new approach involves nurses in the process to help keep physician-owned practices afloat in this insurance-driven market. This article shares the value of precertification in an outpatient infusion center and the role of nurses in this process.
Dohse
Linda
L
Infusion Center, Palmetto Hematology-Oncology PC, Spartanburg, SC 29303, USA. lkdohse4@cs.com
D002173:Cancer Care Facilities; D004608:Eligibility Determination / Q000458:organization & administration*; D019317:Evidence-Based Medicine; D006801:Humans; D007262:Infusions, Intravenous / Q000451:nursing*; D006278:Medicare / Q000458:organization & administration; D017146:Models, Organizational; D024802:Nurse's Role; D009859:Oncology Nursing / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D010347:Patient Care Planning / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D011331:Private Practice / Q000458:organization & administration; D012051:Reimbursement Mechanisms / Q000458:organization & administration*; D013022:South Carolina; D013041:Specialties, Nursing / Q000458:organization & administration*