Re: Reimbursing inpatient lactation services: Judy G.

[Guest guest]

<<an IBCLC, who spent an hour helping one of the moms I mentioned, said that this service was not billable and that the hospital would have to eat the cost. This isn't great for encouraging hospitals to care for post-discharge breastfeeding moms well, if they need to be readmitted for some reason.<<

I have a question. Since I've never been employed by a hospital, I don't know how it works, I guess. If that IBCLC, mentioned above, is working her regular shift and is helping a mom for an hour who has come in (discharged or not), doesn't she just continue to get her salary or hourly wage because she is just doing her job anyway? Or is this being called in and not being allowed to clock in?

It reminds me of the new RN, IBCLC from our community hospital who called me to ask how I get reimbursed. (Um, people pay me, right?) She was complaining that the ped's are all referring to her now and some of the women didn't even deliver at our hospital. How are they to get reimbursed for that? I said, "you get your wage for being there, don't you?"

But, as I write this, I see that maybe they want to bill the person coming in when they don't bill the person who has delivered there.. Is that right? So really it is about giving a free service to the moms that have been their clients but not wanting to help the other mothers but they are pushed into it by the doctor sending them over. Or does the hospital charge an outpatient fee but can't do that for the other moms? Whew, I should call her and ask what the policies are and how we can work together to get some of those women sent over to me.

But bottom line must be that they are still paying the IBCLC it's just that the hospital wants to bill somebody for the time spent. Do I have it right, now?

Cheryl n

To: Sent: Saturday, September 24, 2011 12:26 PMSubject: Reimbursing inpatient lactation services: Judy G.

Fay not all hospitals are set up this way but here's how it works for me.I am 'devoted' to the birth center. When I serve any other unit in my hospital other than the birth center (which is considered L & D and Mother Baby or Postpartum), I transfer my salary to the according cost center, including the NICU.So for my department budgeting purposes, the other department cost center absorbs my costs (we use a Kronos or badge swiping system, I can just transfer myself to that cost center through the Kronos). This does NOT resolve the absence of reimbursement for services to the organization however.This patient is an admitted inpatient. You can't charge an outpatient consult fee, that would be 'double dipping', so that's out of the question.I don't know how it could be billed separately. IBCLC's are not recognized 'providers' (leads us back to licensure and reimbursement discussion)....the IBCLC is a hospital

employee, and this is part of the expected standard of care for this patient. Judy Gutowski who chairs the USLCA licensure and reimbursement committee is on this list and occasionally posts may have some insight.I 'consult' with other departments on a weekly basis practically. Quick phone calls and so forth I don't transfer charges. But my unit is on the 14th floor of a large hospital campus, I can spend more than 10+ minutes just getting to some of these other units!> But this brings up a new question: an IBCLC, who spent an hour helping one of the moms I mentioned, said that this service was not billable and that the hospital would have to eat the cost. This isn't great for encouraging hospitals to care for post-discharge breastfeeding moms well, if they need to be readmitted for some reason.> >>> Sigh - I tried to find the detailed reply that I sent to this msg, and it has disappeared into thin air. So here goes again - plse forgive me if it actually is a duplicate.> > Thank you for the responses (both on and off list) to my concern - I felt very supported!> > I was incredibly relieved yesterday to discover that the info given by the staff nurse on one of the non-Family-birth-Center wards (about the "hospital policy") was INCORRECT! Yay! It is NOT hospital policy - just ill-informed staff (as K hypothesized). I'd hoped that was the case! I spoke with the head of the FBC about the situation, and she said that she would pursue better educating the hospital staff.>

[Guest guest]

I don't think it is a question of where the mother delivered, except that in the

IBCLC's mind she may feel more 'loyal' to a patient who previously utilized

their organization for delivery (not appropriate)but it really shouldn't matter.

Regardless of where the mother delivered it sounds as if they are not set up to

seek reimbursement for any outpatient services whatsoever. So if you could

imagine, a 'specialist' who sees a patient in the hospital. And they also see

outpatients yet they have no ability to 'bill' for their services.

The problem is administrators and bean counters really don't care or know much

about breastfeeding as a health initiative.

And there is NO revenue attached to the outpatient services. The inpatient

services probably don't have revenue associated with them either but it is

becoming an increasingly common expectation that hospitals provide IBCLC

lactation support. So yes, the IBCLC is getting paid her salary, however the

hospital has no revenue associated with the services she is providing, and

therein lies the problem.

>

>  <<an IBCLC, who spent an hour helping one of the moms I mentioned, said that

this service was not billable and that the hospital would have to eat the cost.

This isn't great for encouraging hospitals to care for post-discharge

breastfeeding moms well, if they need to be readmitted for some reason.<<

>

>  

> I have a question.  Since I've never been employed by a hospital, I don't

know how it works, I guess.  If that IBCLC, mentioned above, is working her

regular shift and is helping a mom for an hour who has come in (discharged or

not), doesn't she just continue to get her salary or hourly wage because she is

just doing her job anyway?  Or is this being called in and not being allowed to

clock in?

>  

> It reminds me of the new RN, IBCLC from our community hospital who called me

to ask how I get reimbursed. (Um, people pay me, right?)  She was complaining

that the ped's are all referring to her now and some of the women didn't even

deliver at our hospital. How are they to get reimbursed for that?  I said, " you

get your wage for being there, don't you? "

>  

> But, as I write this, I see that maybe they want to bill the person coming in

when they don't bill the person who has delivered there.. Is that right?  So

really it is about giving a free service to the moms that have been their

clients but not wanting to help the other mothers but they are pushed into it by

the doctor sending them over.  Or does the hospital charge an outpatient fee

but can't do that for the other moms?  Whew, I should call her and ask what the

policies are and how we can work together to get some of those women sent over

to me. 

>  

> But bottom line must be that they are still paying the IBCLC it's just that

the hospital wants to bill somebody for the time spent.  Do I have it right,

now?

>  

> Cheryl n

>

[Guest guest]

,

You wrote: " The problem is administrators and bean counters really don't care

or know much about breastfeeding as a health initiative.

....however the hospital has no revenue associated with the services she is

providing, and therein lies the problem. "

I work for a hospital that is just in this situation. I don't know that the

bean counters even know that there is an IBCLC in the building, nor what she

does, and that they could bill for it Now having said that... I have not had

much success with private patients in my area getting reimbursed from their

insurance for services, so why would it be different for my hospital? If it is,

other than the Reimbursement toolkit, what resource do you suggest?

I have seen outpatients at the hospital, but they are by appointment only, with

only a handful of patients in 6 years being directly sent from the doctor to the

hospital. Many of the patients that I do see have private insurance, but many

also have medicaide. They have given my services free of charge for the first

month after delivery, after that time (or if delivered at another facility) they

are referred to my private practice, LLL or WIC.

Dalton

[Guest guest]

To me this is an issue of licensure and reimbursement and precisely why the

USLCA is trying to seek the licensure of IBCLC's so they can be recognized as

individual providers and bill for their services.

" The problem is administrators and bean counters really don't care

or know much about breastfeeding as a health initiative.

> ...however the hospital has no revenue associated with the services she is

providing, and therein lies the problem. "

>

> I work for a hospital that is just in this situation. I don't know that the

bean counters even know that there is an IBCLC in the building, nor what she

does, and that they could bill for it Now having said that... I have not had

much success with private patients in my area getting reimbursed from their

insurance for services, so why would it be different for my hospital? If it is,

other than the Reimbursement toolkit, what resource do you suggest?

>

> I have seen outpatients at the hospital, but they are by appointment only,

with only a handful of patients in 6 years being directly sent from the doctor

to the hospital. Many of the patients that I do see have private insurance, but

many also have medicaide. They have given my services free of charge for the

first month after delivery, after that time (or if delivered at another

facility) they are referred to my private practice, LLL or WIC.

>

> Dalton

>

[Guest guest]

Hello

Ladies,

Typically

hospitals get no reimbursement for IBCLC services. In fact, they usually lose

money on IBCLC services because they are reimbursed for maternity services as “bundled

care”. This means they get the same dollars per patient whether they are

breastfeeding or bottle feeding mothers. The same regardless of whether the

breastfeeding patient sees a mother or not. There is an extended nursing code

that might be able to be billed for IBCLC visits for in-patients, you could check

with your billing department about that – this is not specific to

lactation services. There is no independent reimbursement for IBCLC services

for in-patients.

In some

hospitals, there are out-patient consults provided by IBCLCs; some limit to

those who have delivered at their facility, others do not. Some hospitals

charge cash fees for outpatient lactation services, others do not at all. If

the visits meet the supervisory qualifications, then some can be billed as

99211 nurse visits, but these are very low reimbursement visits, in the

neighborhood of $20. I know of one hospital that charges a “facility fee”

of $50 for out-patient visits. It isn’t coverage of lactation per se, but

at least they can recoup some costs for the service. Otherwise, out-patient

visits are not reimburseable unless there is a physician on the premises to

oversee and “incident –to” billing can be used or the IBCLC

has another billable license.

In ’s

example, at least the hospital keeps track of where the services she provides

are being used and it charges them to the correct cost center. Not many other

hospitals do this. For more on the topic of how to do this see the USLCA document

“Five Steps to Improving Job Security” http://www.uslcaonline.org/documents/Job%20Security/5_STEP_HANDOUT3.pdf

IBCLCs

are not independently reimburseable and that is the reason our committee

continues to advocate for this in legislative and policy initiatives.

I am

writing a new document to address this and all of the other questions you all

were asking me back in August regarding reimbursement. I haven’t

forgotten. Your questions were the impetus for educating IBCLCs in the US about this

issue. Thanks for the inspiration and I will let you know when it is done.

Judy

Judith

L. Gutowski, BA, IBCLC, RLC

135 McGrath Lane

P Box 1

Hannastown, PA 15635-0001

Cell

Phone

Fax

[Guest guest]

Thanks Judith,

I didn't think that I had totally missed the boat. Our hospital had considered

having me " charge " for my services, but then figured out that it would be

difficult with time and energy to input the charges into the computer, so they

dropped it. They instead used it as a marketing tool to show how much they

" Support " breastfeeding... to get free prenatal classes, visits from LC in

hospital, and free follow-up after discharge.

THanks for the hard committee work,

Dalton