Charge Nurse Workshop10/26/09

Edited 12/21/09 by Jessica Donohue, RN

Adjusted for med-surg units 7a,8d

What are Accommodation Codes?Daily (24 hrs.) Patient Billing Assignments made

by the RN assigned to each patient via the Nursing Operations Database (NOD)Intensive Care, Intermediate Care, Acute Care,

Nursery Levels I-IV

In the summer of 08’ the hospital instituted nurse staffing ratios based upon two criteria. 1. The patient's severity of illness and 2. The intensity of nursing interventions

The product used by MUHA which sets the starting standard for this is called InterQual (Nurseries use DHEC/Medicaid guidelines)

InterQual? Tell me moreInterQual evidence-based clinical decision

support criteria are used by thousands of organizations in healthcare.

Used to answer critical questions about the appropriateness of levels of care and resource use

How does InterQual apply to nursing activities?Dr. Cawley, our Executive Medical

Director, began chairing an InterQual meeting in September 2008.

The purpose of this meeting is:To review requests for changesProvide consistency in decision making

when allowing changesEnsure that clinical criteria are the

basis for change

How To Get InvolvedNurse managers are invited to attend the

InterQual Meeting every other Monday at 10:00 am in room 295 MH. 

Staff RNs are welcome to attend with their manager to present any patient nursing care indicators that may warrant a change. 

The InterQual Committee sends a reviewed list of indicators to the nurse managers periodically with updates and it is posted on the NOD.

 When you select the InterQual indicators, you are determining part of the patient’s bill. 

To Ensure Appropriate Billing Practices

InterQual indicators should never be selected unless actual care has been provided and documented.  

InterQual criteria must be entered into the Nursing Operational Database (NOD) by 10:00 pm daily.  Patients are billed at midnight based on their

midnight to midnight care (24 hours) for the CURRENT date. 

After 10:00 pm, if the patient condition changes from routine to intermediate status enter the new criteria and notify the Admit Transfer Center so they may adjust billing prior to midnight. 

To Ensure Appropriate Billing Practices

No patient should have “not done” in the Accommodation Code column.

Audits of the records for the following indicators have frequently shown no supporting documentation: 

Neurologic Assessments (all indicators) Anti-Infectives (all indicators)

Accommodation Code AssignmentsRNs select standard criteria to justify the

intermediate accommodation code assignment, if applicable.

Anytime during a 24 hour (midnight to midnight) period a patient meets intermediate criteria, the RN will assign the intermediate accommodation code.

Charge Nurse verifies at 10:00pm that accommodation codes are reviewed and properly assigned for each patient. (Charge Nurse Report)

Any criteria selected must be documented in the patient record.

Access to Nursing Operations Database Click on Nursing Operations Database ICON

or Link on the front page of the Medical Center

Intranet (frequently used links)Type OACIS Log In and Password

Click

Click

Click

Click

Click

Charge Nurse Verifies Accommodation CodeEvery evening at 10:00pm the charge RN must

verify that every patient has an accommodation code.

Every night at midnight (after the patient’s day has been billed) the accommodation code assignment for each patient defaults back to “Not Done” status.

Call Admission Transfer Center (ATC) if the patient has been discharged and remains on the roster. (Right Patient, Right Bed)

Call ATC (2-3306) if a patient occupies a bed that is not on the roster.

If patient condition changes between 10:00pm and midnight, call ATC and update the accommodation code criteria.

Changing Codes that have been EnteredMed-Surg Areas

Intermediate to Routine Accommodation Code Report - Med-Surg “Change” option available (under “edit” column) if

code changes are required (e.g. if accidentally entered for wrong patient)

“Change” opens up the record so that you can update previously selected information

Routine to Intermediate Click on “routine” option (under “accommodation

code” column) and select updated indicators to change accommodation code assignment

ICU’s Click on “ICU”, “Intermediate (ICU)” or “Routine”

option (under “accommodation code” column) and select updated indicators to change accommodation code assignment

Summary QuestionsOnly RNs can assign Accommodation Codes.

(TRUE)The accommodation code reflects the patient care received from midnight to midnight.

(TRUE)

Summary Questions (cont.)•It is okay to leave a patient accommodation code as “Not Done”. (FALSE)

Any criteria selected must be documented in the patient record.

(True)

Summary Questions (cont.)Billing a patient at an intermediated level

without appropriate documentation is considered billing fraud.

(True) A continuous pulse ox or apnea monitoring

requires a doctors order to be written in the chart in order for the patient to be at an intermediate level?

(True)

Summary Questions (cont.)If the patient has a normal gtube, ng tube, is

on NG feeds or has Gtube meds, you can check that they have GI suction/drainage.

(True)