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What Are the Best Tips for Critical Care Billing?

By Alex Newth
Updated May 17, 2024
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Critical care billing is a sensitive issue in the medical field, because there typically are many laws surrounding this type of billing and, because this type of care typically incurs higher costs, the patient may refute 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 means the patient is using a stable amount of medication. When the critical care cost is billed, the form should report the exact reason for the critical care, to ensure the patient and insurance company that critical care was required. Two or more doctors may see the patient at the same time, but only one can bill for critical care at once. Only the exact amount of time in critical care should be billed; otherwise, there can be legal battles.

Sometimes doctors or reviewers file a patient’s status as stable, but they do not mean the patient ready to leave critical care. Instead, they mean the patient is taking a stable amount of medication or is only stable because of medication. Not writing this on the critical care billing form may confuse the patient and insurance company about further critical care charges. If this definition of stable is being used, then it should be clearly explained when filed.

When critical care billing is entered, the person processing the form also should enter a reason why critical care is necessary. For example, if an organ has failed or if extreme bleeding cannot be stopped, then this should be noted on the form. If not, then the patient may be able to fight the critical care costs, because there are no verifiable reasons attached to them.

Someone in critical care often will need several doctors to help stabilize his or her condition. Even if all the doctors are working on the patient at the same time in critical care, only one can charge for critical care at a time. To split this, the doctors can choose one doctor to get all the extra money, or they can split it by hour. For example, one doctor bills for critical care the first hour, then the second doctor bills for the second hour.

Time is a major factor in critical care billing, because each minute will accrue extra charges against the patient. Due to this, the bill should only reflect the exact amount of time the person received critical care. For example, if he or she received critical care for 37 minutes, it should not be rounded up to 40. Rounding up may cause legal battles if the patient finds out he or she was overcharged.

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