AMBULATORY ONCOLOGY NURSE BILLING AND CHARGE CAPTURE: OPPORTUNITIES DEVELOPED DURING POST-COVID RECOVERY

ABSTRACT

Oncology Nursing Practice COVID-19 recovery presented nursing leadership with opportunities to document productivity measures for oncology nursing services rendered and potentially impact revenue. A nurse billing and charge capture committee composed of network nursing and revenue department team members was convened to establish billable and productivity related nursing tasks. The purpose was to identify ambulatory oncology nursing practice that would generate billable revenue, identify non-billable tasks that could generate statistical codes to measure productivity, and create an educational plan to implement changes in nursing practice to support billing. Committee leads identified key stakeholders from each of the health system network sites to participate. The committee assessed and categorized nursing practice into actions such as central line maintenance and phlebotomy to support nursing revenue (billable) versus distinct productivity measures that were documented by nursing time (non-billable). Both groups included the nursing professional development specialists who engaged nursing informatics and the IT department. Their collaboration led to standardized nursing documentation using EPIC smart phrases, charge capture codes, and stat codes for productivity. The revenue integrity team ensured charges and statistical codes were compliant with regulatory standards. EPIC analysts optimized nursing documentation by creating smart phrases to support billing and track nursing time. Departmental reports used the smart phrases to identify patients to support nursing documentation compliance. For non-billable items, the smart phrases and documented time interval were used to capture productivity. The reports were monitored for nursing documentation and charge capture compliance. In the first two fiscal quarters, 1,421 nurse billing items were documented as well as 1,648 non-billable items that totaled over 440 hours of nursing time. Results were discussed at leadership and staff meetings. The revenue group identified and prioritized a list of oncology nursing functions that were associated with chargeable specific Current Procedure Terminology (CPT) codes. Initially, two nursing tasks, central line maintenance and therapeutic phlebotomy, were implemented. Other chargeable tasks that followed included in person chemotherapy and pre-operative/post-operative teaching visits, port assessment, chemotherapy pump and peripheral line assessment follow up, dressing changes and skin assessment. The productivity group defined and prioritized a list of productivity measures which included telephone encounters, authorization and registration, form completion (FMLA, disability, prior authorization, and oral medications), chemotherapy and preoperative/postoperative teaching which occurred in tandem with provider visits or by video or telephone.