April 1, 2023
By Bruce W. McCollum
Long-Term Care Project Manager and Reimbursement Specialist
The evolution of billing practices in community-based care requires those experienced with Medicare and Medicaid platforms to embrace a paradigm shift. While Medicare typically reimburses nursing services on a per-visit basis, non-Medicare cases—such as Michigan no-fault auto insurance or workers’ compensation—demand precise hourly billing. This transition emphasizes the importance of detailed time documentation and its ethical representation in care records.
Hourly billing necessitates a meticulous approach to time tracking and justification. At the top of each nursing document, providers should clearly indicate start and end times, total hours, and a brief explanation of why skilled care was necessary. This explanation should align with the authorizing physician’s orders, providing immediate clarity for adjusters or reviewers. A concise data box, summarizing key points, offers a streamlined yet transparent view of the time invested, and the services rendered.
In cases where older documentation must be reorganized for clarity, the ethical imperative remains unchanged. Transferring identical nursing data into an easier-to-digest format ensures accuracy and compliance. This practice honors the integrity of the original records, facilitating ethical billing without altering the factual basis of the documentation.
By adopting these methods, providers can ensure their practices align with ethical standards while adapting to the demands of modern billing platforms. This approach not only safeguards against disputes but also enhances trust between care providers and payers, reinforcing the credibility of community-based care services.
Another Blog Post by Direct Care Training & Resource Center, Inc. Photos used are designed to complement the written content. They do not imply a relationship with or endorsement by any individual nor entity and may belong to their respective copyright holders.
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