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.