Emerging Nurse Billing and Reimbursement Models.

Area of Science:

• Healthcare Economics
• Nursing Administration
• Health Services Research

Background:

• Nurses are the largest healthcare professional group, accounting for a significant portion of hospital costs.
• Current nursing care costs are largely obscured within daily room and board charges.
• Lack of direct billing for nursing services hinders accurate cost allocation and reimbursement.

Purpose of the Study:

• To explore and recommend direct billing and reimbursement models for nursing care in the US.
• To develop methods for identifying and costing nursing services.
• To facilitate financial recognition of nursing contributions.

Main Methods:

• Literature review of historical and recent costing and billing practices for nursing care.
• Synthesis of findings to propose new billing and reimbursement models.
• Analysis of feasibility for implementation across healthcare settings.

Main Results:

• Two primary billing models are proposed: 1) Allocating nursing time per patient daily, separate from facility charges. 2) Expanding Current Procedural Terminology (CPT) codes for specific nursing activities and interventions.
• These models enable the identification of patient-level nursing intensity and services provided.
• The proposed methods are applicable across all settings where nursing care is delivered.

Conclusions:

• Implementing direct billing for nursing care is feasible in the United States.
• The proposed models allow for accurate identification of nursing intensity, costs, and interventions.
• This shift can lead to better financial recognition and resource allocation for nursing services.