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ICU billing requires accurate reporting of the reason for critical care and the exact amount of time spent in the ICU. Multiple doctors can treat a patient, but only one can bill for critical care at a time. Misleading reports of a patient’s stability can cause confusion and disputes over billing.
ICU billing is a sensitive issue in the medical field, as there are typically many laws related to this type of billing, and since this type of care typically involves higher costs, the patient can dispute the billing if it is incorrect. Some critical care billing forms may report that a patient is stable, which is misleading when the doctor only indicates that the patient is using a stable amount of medication. When billing for critical care, the form must state the exact reason for the critical care, in order to assure the patient and the insurance company of the need for critical care. Two or more doctors can see the patient at the same time, but only one can bill for critical care at a time. Only the exact amount of ICU time should be billed; otherwise, there may be legal battles.
Sometimes doctors or reviewers define a patient’s status as stable, but they don’t mean the patient is ready to leave critical care. Instead, they mean that the patient is either taking a stable amount of medication or is stable just because of the medication. Not writing this on the critical care billing form can confuse the patient and the insurance company regarding additional critical care charges. If this definition of building is used, it should be clearly explained when filed.
When critical care billing is entered, the person processing the form must also enter a reason why critical care is needed. For example, if an organ has failed or if extreme bleeding cannot be stopped, this should be noted on the form. Otherwise, the patient may be able to fight the costs of critical care because there are no verifiable reasons associated with it.
Someone in the NICU will often need several doctors to help stabilize their condition. Even if all doctors are working on the ICU patient at the same time, only one can charge for ICU at a time. To split this, doctors can choose one doctor to get all the extra money, or they can split it by the hour. For example, one doctor bills ICU for the first hour, then the second doctor bills for the second hour.
Time is an important factor in ICU billing, as every minute will accrue additional costs for the patient. Because of this, the bill should only reflect the exact time the person received critical care. For example, if he received critical care for 37 minutes, he shouldn’t be rounded up to 40. Rounding can cause legal battles if the patient discovers they have been overcharged.
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