Streamlining Charges – Instinct EMR Tips and Guidelines

Instinct EMR is built to help you streamline your hospital charging! Below is our guide to charging recommendations and best practices. 

---

Table of Contents

Hospitalization Charging Recommendations

CRI / IV Fluid Charging Recommendations

Oral Medications Best Practices

Injectable Medication Best Practices

Shift Charges and Automatic Fees

---

🏥 Hospitalization Charging Recommendations

EMR has the ability to automate your hospitalization charging to help simplify things during a patient’s visit. We recommend having a hospitalization charging system that will cover your hospital’s needs for various scenarios. 

Hospitalization charges are chosen from the drop-down menu on the Tx Sheet. Instinct will begin to charge at the time of selection unless specified otherwise (more on this below) and will continue to charge at the frequency assigned to the Instinct invoice until the patient is checked out or the hospitalization level is changed.

Frequency: Most hospitals simply charge per shift such as every 12 hours or every 24 hours. Including a range of time within the description will help communications with clients. Example: Hospitalization Level 1 (1-12 hours). So regardless if the patient is hospitalized 3 hours or 10 hours, they will be charged that 1-12 hr shift fee.

Instinct is also able to set a preferred start time for hospitalization. For example, if your hospitalization always starts at 8 am, we can set charging to begin at 8 am. This means if you charge for hospitalization q12 and the drop down is selected at 6 am, the first charge will land on the invoice at 8 am. If it’s selected at 10am, the first charge will land on the invoice at 8 pm.

Some hospitals find that having the charges start at the time of check-in is very helpful, so it is automatically set, and it is one less thing to think about during the admit process.  This means, patients that are checked in as Outpatient, will start the hospitalization at the time the patient is checked in.

We also recommend eliminating hospitalization charges by weight as Instinct does not support this functionality.

💡ProTip: In the Careville article, Common Hospitalization Workflows you will find other plans that may better fit your hospital’s invoicing needs!

---

💧 CRI / IV Fluid Charging Recommendations

CRI (constant rate infusions) charging

Through the Admin section, consider creating a specific automatic charge that can be attached to the patient’s CRI. These can be linked to the CRI vitals and will automatically charge a fee at a certain frequency. 

Some examples of this include:

• Set Up Fee (Once)
• CRI Administration/Monitoring (1-12 hours)
• Syringe Pump Usage/Monitoring (1-12 hours)

When viewing the Tx Sheet, the CRI will fall under the Continuous Infusions section and it will include the small-dollar sign icon that represents the Automatic Charges.

Your hospital may choose to incorporate the charge of the medication into the fees listed above. This will not be able to capture the ‘ mLs’ of the medication if your hospital chooses to do this for record-keeping purposes.

In that case, you can use the One-Off feature to capture the medication and mLs used and over-communicate in the treatment notes section.

💡ProTip: Ordering, Charging, & Changing Fluids, Additives, and CRI’s

IV Fluid Charging

Having a shift charge that covers the cost of set up, administration, monitoring,  fluids, and supplies in one fee may be ideal depending on your hospital’s needs. A few options you can try are:

• Fluid Pump (Once)
• IV Fluid Monitoring (1-12 hours)
• Extension set/admin set (Once)

Once on the Tx Sheet, the IV Fluids – LRS will fall under the Continuous Infusions section and it will also include the small-dollar sign icon that represents the Automatic Charges.

Once the treatment is completed, the automatic charges for the fluids will populate onto the invoice.

If IV Fluid bag charge capture is a need at your hospital for inventory purposes, using the One-Off feature to capture when a new bag is opened can be used as seen below.

---

💊 Oral Medications Best Practices

We find that a lot of missed charges are due to removing medications off the shelf per treatment. Hospitals struggle to capture every inventory item removed off the shelf which may result in having inaccurate counts and can easily run out of medication if inventory personnel is not notified in a timely manner. 

Clients may question itemized charges ‘per pill’ on an invoice and find that a price or dispensing fee may be over-priced or question administration fees on top of price per pill which leads to uncomfortable and unnecessary discussions. Also, estimating the costs of medications beforehand to a client can be a struggle. 

We find the best way to capture these types of fees is to ‘hide’ these charges under a service that can’t be negotiated, for example, hospitalization charges.

In-patient Meds

The best way to capture the medication fees is to fill a prescription before the treatments are scheduled.  Estimate the length of time the patient will be hospitalized and the amount of medication that will be needed during their stay. Capturing the cost of the medication along with the appropriate dispensing fees for a prescription will keep your inventory counts accurate and will help your inventory team! 

Administration fees

We recommend not charging a separate administration fee to administer the medication.  Most hospitals choose to increase the price of their hospitalization levels to accommodate this service.  Plus, a majority of inpatients will be receiving medications anyway so what better way to capture this service through your hospitalization charges.

Owner’s Meds

As mentioned above, it is recommended to not charge a separate administration fee to administer ‘owner’s meds’ (OM in front of the medication name typically means there is no charge associated) but rather incorporate this fee into your hospitalization levels.

---

💉 Injectable Medication Best Practices

Some hospitals use “Tiered Pricing” where the cost for an injectable medication is calculated based on weight, outpatient injection vs inpatient injection, etc. This is a very difficult way to capture charges effectively and also to estimate charges for a client before hospitalization.

• What happens if the patient weight changes? 
• What happens if the same medication given has different pricing on an invoice?

These cause very difficult conversations with a client and also becomes difficult to control inventory. 

We find that capturing charges ‘per mL’ given will ensure streamlined charging and will help with quantity on hand for ordering purposes.

• Injections should be set to charge with a cost ‘per mL’ and if needed, a dispensing fee, minimum and/or maximum fee
• Regardless if the injection is given on an outpatient basis vs. inpatient basis, or first injection vs. second injection, it still is the same action, same cost, same supplies used so why not keep the price the same?

Administration fees

The best way to incorporate an administration fee with your injections is to apply a dispensing fee to the product.  This way, the price is rolled into one on the invoice. For example:

• Famotidine injectable:  has a price of $1.20 per mL and a dispensing fee of $35.00.  So if 2 mLs is given, the cost will be on one line item: Famotidine injectable = $37.40
• This will eliminate the need to charge a separate administration fee that a client can question.
• This will also eliminate ‘missed’ charges where staff may conveniently ‘forget’ to add the administration fee on the invoice.

---

⏲ Shift Charges and Other Automatic Charges

The best way to capture fees automatically for those services that are done on a ‘timed basis’ is to create Automatic Charges in Instinct. These charges will automatically go to the invoice when a specific item is ordered and will continue to charge at a set frequency of time. Staff will not have to remember to enter these charges since they will be automatically captured. Some examples of automatic fees are:

---