Many hospitals struggle with revenue capture within the emergency department (ED). They lack either the reporting capabilities or the revenue cycle functionality to proactively identify trends that can impact financial viability. Most focus on capturing all physician services delivered within the ED. Often, less attention is paid to recognizing revenue from nursing procedures.
Nursing activity can be reflected by six baseline CPT codes: 96360 for intravenous infusion, hydration, initial 31 minutes to 1 hour, and 96361 for each additional hour; 96365 for intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug), initial up to 1 hour, and 96366 for each additional hour; 51701 for insertion of non-indwelling bladder catheter; and 51702 for insertion of temporary indwelling bladder catheter, simple. These six CPT codes have a direct correlation to facility ED margin and overall patient acuity. The total, compliant capture of these services depends upon nursing accountability, documentation, coding knowledge, application of chargemaster methodologies, and business office capabilities. In short, utilization and associated revenue capture of these codes can be a useful diagnostic tool of the health of a hospital's ED revenue cycle.
To demonstrate the potential value of these six CPT codes as a diagnostic tool, an analysis looked at actual claims data, documentation, and operational reviews from 25 hospitals varying in size from 25 to 99 beds. The purpose of the analysis was to measure the extent to which improvements identified as a result of attention to these six codes translated into improved revenue capture associated with each code. In several instances, the hospitals increased their training on documentation at the nursing level and gave the nurses more opportunities and access to resources and subject matter experts that allowed the nurses to more readily recognize revenue for their services. These steps resulted in expanded ownership and accountability at the nursing level. The increased nursing ownership not only directly affected nursing revenue but also increased physician procedural capture, lowered lag days, and reduced compliance concerns.
Hospitals in the study were grouped into quartiles based on their ability to achieve threshold amounts on improvement in revenue capture.
On looking at the increase in gross revenue capture by quartile, as measured by gross revenue, the analysis disclosed that the median improvement in revenue cycle performance across these six CPT codes among the 25 hospitals in the data set was $218,583 in total annual gross revenue.
The analysis also compared the 25 hospitals' performance for the six CPT codes by quartile prior to implementing revenue cycle changes with their performance by quartile after implementing revenue cycle changes. Prior to implementation, revenue capture from hydration, infusion, and catheterization nursing services equaled 0.30 percent of total gross revenue for the median hospital. After implementation, these same services yielded 1.60 percent of total gross revenue for the median hospital in the data set.
By focusing on these six CPT codes, hospitals can identify important opportunities to better capture revenue in the ED, while also demonstrating the value such improvements to key constituencies, thereby fostering support from leadership for needed changes to revenue cycle procedures throughout not only the ED but also the entire organization.
This analysis was developed by Stroudwater Associates, Portland, Maine. For more information, contact John Behn at email@example.com.
Publication Date: Monday, July 02, 2012