Title: Section 444.19 - Ambulatory services expenses description

444.19 Ambulatory services expenses description. (3260)

(a) 6710 EMERGENCY SERVICES

6711 Emergency Room

6712 Observation

6719 Other Emergency Services

(1) Function. Emergency Services provides emergency treatment to the ill and injured who require immediate medical or surgical care on an unscheduled basis. Additional activities include, but are not limited to, the following:

Comforting patients; maintaining aseptic conditions; assisting physicians in performance of emergency care; monitoring of vital life signs; applying or assisting physician in applying bandages; coordinating the scheduling of patient through required professional service functions; administering specified medications; and infusing fluids, including I.V.'s and blood.

(2) Description. This cost center contains the direct expenses incurred in providing emergency treatment to the ill and injured. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(3) Standard Unit of Measure: number of visits. A visit is each registration of a patient in the emergency services unit of the hospital. Multiple services performed in the emergency services unit during a single registration (e.g., encounters with two or more physicians, two or more occasions of service, any combination of one or more encounters and occasions of service) are recorded as one visit. Services provided to emergency patients in ancillary cost centers are not included here, but are included in the applicable ancillary cost center.

(4) Data source. The number of visits shall be the actual count maintained by Emergency Services.

(b) 6720 CLINIC SERVICES (1) Function. Clinics provide organized diagnostic, preventive, curative, rehabilitative and educational services on a scheduled basis to ambulatory patients. The cost of therapy services such as physical therapy, speech-language pathology, occupational therapy and respiratory therapy must be reported in the appropriate ancillary cost centers. Additional activities include, but are not limited to, the following:

Participating in community activities designed to promote health education; assisting in administration of physical examinations and diagnosing and treating ambulatory patients having illnesses which respond quickly to treatment; referring patients who require prolonged or specialized care to appropriate other services; assigning patients to doctors in accordance with clinic rules; assisting and guiding volunteers in their duties; making patients' appointments through required professional service functions.

(2) Description. These cost centers contain the direct expenses incurred in providing clinic services to ambulatory patients. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(3) Standard Unit of Measure: number of visits. A visit is each registration of a patient in a formally organized clinic of the hospital. Multiple services performed in the clinical unit during a single registration (e.g., encounters with two or more physicians, two or more occasions of service, any combination of one or more encounters and occasions of service) are recorded as one visit. Visits made by clinic patients to ancillary cost centers are not included here but are accumulated in the appropriate ancillary cost center.

(4) Data source. The number of visits shall be the actual count maintained by the formally organized clinic within the hospital.

(c) 6810 HOME PROGRAM DIALYSIS EQUIPMENT-100%

(1) Function. This cost center provides medically necessary dialysis equipment for dialysis patients capable of administering their own treatment in their homes. The cost center provides, obtains, or arranges for the provision of:

(i) artificial kidney and automated peritoneal dialysis machines, including supportive equipment such as blood pumps, heparin pumps, bubble detectors and other alarm systems. (Supportive equipment does not include items not used in conjunction with delivery systems, such as scales, blood pressure apparatus and other diagnostic devices);

(ii) dialysis equipment installation, maintenance and repair; and

(iii) dialysis equipment reconditioning for subsequent use.

Hospitals so electing will be reimbursed by the Medicare program 100 percent of the reasonable costs incurred by the provision of such home dialysis equipment. Additional activities include, but are not limited to, the following: Water testing; making minor plumbing and electrical changes to accommodate the equipment; delivering the equipment; replacing water filters on reverse osmosis devices; providing minor parts to the patient for patient-performed maintenance; transporting equipment for installation and reconditioning. (2) Description. This cost center contains the direct expenses incurred in providing dialysis equipment, for patients dialyzing at home, for which the hospital will be reimbursed 100 percent of the reasonable cost. Included as direct expenses are: Salaries and wages, employee benefits, professional fees, supplies, purchased services, and other direct expenses. As an exception to the requirement to report all equipment maintenance expense in the Plant Operations and Maintenance cost center, dialysis equipment maintenance expense must be reported in this cost center.

(3) Standard Unit of Measure: number of patient months. Count as one, each month or major portion thereof, each home dialysis patient who is in the 100 percent reimbursement home dialysis program.

(4) Data source. Departmental records.

(5) Effective date. Reporting periods beginning in 1980 and thereafter.

(d) 6820 HOME PROGRAM DIALYSIS-OTHER

(1) Function. The Home Program Dialysis-Other cost center provides home dialysis support services for dialysis patients capable of administering their own treatment in their home. This program obtains or arranges for the provision of:

(i) medically necessary dialysis equipment as prescribed by the attending physician;

(ii) dialysis equipment installation, maintenance and repair services;

(iii) all necessary medical supplies; and

(iv) the services of trained home dialysis aides, where necessary.

Additional activities include, but are not limited to, the following: Periodic monitoring of patient's home adaption to self-dialysis in accordance with patient care plans; home visits by qualified provider personnel; testing and appropriate treatment of water.

(2) Description. This cost center contains the direct expenses incurred in providing home program dialysis services to self-care home dialysis patients other than such expenses included in account 8810, Home Program Dialysis Equipment--100%. As an exception to the requirement to report all patient-chargeable supplies in the Medical Supplies Sold cost center (account 7110), home program dialysis patient-chargeable supplies are to be included in this cost center.

(3) Standard Unit of Measure: number of patient months. Count as one, each month or major portion thereof, each home dialysis patient who is in the home dialysis program. These patients are those not in the 100 percent reimbursement home dialysis program.

(4) Data source. Departmental records.

(5) Effective date. Reporting periods beginning in 1980 and thereafter.

(e) 6830 AMBULATORY SURGERY SERVICES (1) Function. Ambulatory Surgery Services are those surgical services provided to outpatients in a discrete outpatient surgical suite by specially trained nursing personnel who assist physicians in the performance of surgical and related procedures both during and immediately following surgery. Additional activities include, but are not limited to, the following:

Comforting patients in the operating room; maintaining aseptic techniques; scheduling operations in conjunction with surgeons; assisting surgeon during operations; preparing for operations; cleaning up after operations to the extent of preparation for pickup and disposal of used linen, gloves, instruments, utensils, equipment and waste; arranging sterile setup for operation; assisting in preparing patients for surgery; inspecting, testing and maintaining special equipment related to this function; preparing patient for transportation to recovery room; counting sponges, needles and instruments used during operation; enforcing safety rules and standards; monitoring patient while recovering from anesthesia.

(2) Description. This cost center contains the direct expenses associated with a separately identifiable outpatient surgery room. When a common operating room is used for both inpatients and outpatients, the direct costs for both must be accumulated in the "Operating Room" (account 7040). Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(3) Standard Unit of Measure: number of surgery minutes. Surgery minutes are the difference between starting time and ending time, defined as follows:

Starting time is the beginning of anesthesia administered in the room in which the procedure is to be performed (or surgery if anesthesia is not administered or if anesthesia is administered in other than the operating room). Ending time is the end of surgery.

(4) Data source. The number of surgery minutes shall be an actual count obtained from the surgery room operating log.

(f) 6840 PSYCHIATRIC DAY AND NIGHT CARE SERVICES (1) Function. The Psychiatric Day and Night Care Services provides intermittent care to patients, either during the day with the patient returning to his home each night, or during the evening and night hours with the patient performing his usual daytime functions. (2) Description. This cost center contains all the direct expenses of maintaining Psychiatric Day and Night Care Services. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(3) Standard Unit of Measure: number of visits. A visit is each registration of a patient in a formally organized Psychiatric Day and Night Care unit of the hospital. Multiple services performed in the Psychiatric Day and Night Care unit during a single registration (e.g., encounters with two or more physicians, two or more occasions of service, any combination of one or more encounters and occasions of service) are recorded as one visit.

(4) Data source. The number of visits shall be the actual count maintained by the Psychiatric Day and Night Care Services unit.

(g) 6850 AMBULANCE SERVICES (1) Function. This cost center provides ambulance service to the ill and injured who require medical attention on a scheduled and an unscheduled basis. Additional activities include, but are not limited to, the following:

Lifting and placing patient into and out of an ambulance; transporting patients to and from the hospital; first aid treatment administered by a physician or paramedic prior to arrival at the hospital.

(2) Description. The cost center contains the direct expenses incurred in providing ambulance service to the ill and injured. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(3) Standard Unit of Measure: number of occasions of service. Ambulance service provided a patient is counted as one occasion of service regardless of special services rendered at the point of pickup or during transport. For example, the administration of oxygen and first aid during the pickup and delivery of the patient would not be counted as a separate occasion of service.

(4) Data source. The number of occasions of service shall be the actual count maintained by Ambulance Services.

(h) 6860 OTHER AMBULATORY SERVICES (1) Description. This cost center contains the direct expenses incurred in maintaining ambulatory services not specifically required to be included in Emergency Services, Clinic Services, Home Program Dialysis, Ambulatory Surgery Services, Psychiatric Day and Night Care Services, Ambulance Services, Free Standing Clinics Services, or Home Health Services cost centers. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(2) Standard Unit of Measure: none required. Not applicable.

(i) 6870 FREE STANDING CLINIC I

6880 FREE STANDING CLINIC II

6890 FREE STANDING CLINIC III

(1) General. Three zero level accounts have been established for this function to provide for the reporting of up to three discrete Free Standing Clinics. The designations I, II and III do not indicate the level of care. The function, description, standard unit of measure and date source below apply to each Free Standing Clinic.

(2) Function. Free Standing Clinics provide organized diagnostic, preventive, curative, rehabilitative and educational services on a scheduled basis to ambulatory patients at locations other than on the hospital grounds. The cost of therapy services such as physical therapy, speech-language pathology, occupational therapy and respiratory therapy must be reported in the appropriate ancillary cost centers. Additional activities include, but are not limited to, the following:

Participating in community neighborhood activities designed to promote health education; assisting in administration of physical examinations and diagnosing and treating ambulatory patients having illnesses which respond quickly to treatment; referring patients who require prolonged or specialized care to appropriate other services; assigning patients to doctors in accordance with clinic rules; assisting and guiding volunteers in their duties; making patients' appointments through required professional service functions.

(3) Description. This cost center contains the direct expenses incurred in providing clinic services to ambulatory patients. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other expenses, and transfers.

(4) Standard Unit of Measure: number of visits. A visit is each registration of a patient in a free standing clinic of the hospital. Multiple services performed in a free standing clinic during a single registration (e.g., encounters with two or more physicians, two or more occasions of service, any combination of one or more encounters and occasions of service) are recorded as one visit. (5) Data source. The number of visits shall be the actual count maintained by the free standing clinics.

(6) Effective date. The reporting of Free Standing Clinic II (account 6880) and Free Standing Clinic III (account 6890) is optional for cost reporting periods beginning in 1980. For cost reporting periods beginning in 1981 and thereafter, reporting these cost centers separately is required.

(j) 6910 HOME HEALTH--SKILLED NURSING CARE (1) Function. Home Health--Skilled Nursing Care is part-time or intermittent nursing care provided by or under the direct supervision of a licensed nurse (R.N., L.P.N. or L.V.N.) to patients in their residence on the basis of physician's orders and an approved plan of care established and periodically reviewed by the physician. It consists of care in which the patients require convalescent and/or major restorative services at a level less intensive than institutional requirements. Activities include, but are not limited to, the following: Administration of parenteral medication (e.g., intravenous and intramuscular injections or insertion of catheter); changing of dressings and cleansing of wounds; irrigations; enemas; colostomy care; urethral catheter care; administration of oxygen and certain drugs through inhalation of positive pressure; vital signs; observing and recording psychiatric symptoms.

(2) Description. This cost center contains the direct expenses incurred in the provision of skilled nursing care to patients normally at their place of residence. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services and other direct expenses.

(3) Standard Unit of Measure: number of home visits. A home visit is a personal contact in the place of residence of a patient made for the purpose of providing a service by a member of the staff of the home health agency or by others under contract or arrangement with the home health agency. Visits by therapists are not included here but in the appropriate ancillary cost center. If a visit is made simultaneously by two or more persons from the home health agency to provide a single service, for which one person supervises or instructs the other, it is counted as one visit (see Example 1). If one person visits the patient's home more than once during a day to provide services, each visit is recorded as a separate visit (see Example 2). If a visit is made by two or more persons from the home health agency for the purpose of providing separate and distinct types of services, each is recorded--i.e., two or more visits (see Example 3).

(i) Example 1. If two nurses visit the patient together to provide nursing services and one is there to supervise the other, one visit is counted.

(ii) Example 2. If a nurse visits the patient in the morning to dress a wound and later must return to replace a catheter, two visits are counted. However, if the nurse visits the patient in the morning to dress a wound and to replace a catheter, one visit is counted.

(iii) Example 3. If a nurse visits the patient to replace a catheter and at the same time the patient is visited by a home health aide to provide home health aide services, two visits are counted.

(4) Data source. Departmental records.

(5) Effective date. Reporting periods beginning in 1980 and thereafter.

(k) 6920 HOME HEALTH SERVICES--MEDICAL SOCIAL SERVICES (1) Function. Home Health--Medical Social Services is the provision of counseling and assessment activities which contribute meaningfully to the treatment of a patient's condition. These services must be under the direction of a physician and must be given by or under the supervision of a qualified medical or psychiatric social worker. Such services include, but are not limited to, the following: assessment of the social and emotional factors related to the patient's illness, his need for care; his response to treatment and his adjustment to care; appropriate action to obtain casework services to assist in resolving problems in these areas; assessment of the relationship of the patient's medical and nursing requirements to his home situation, his financial resources, and the community resources available to him.

(2) Description. This cost center contains the direct expenses incurred in the provision of Medical Social Services within the context of Home Health Care. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services and other direct expenses.

(3) Standard Unit of Measure: number of home visits. A home visit is a personal contact in the place of residence of a patient made for the purpose of providing a service by a member of the staff of the home health agency or by others under contract or arrangement with the home health agency. Visits by therapists are not included here but in the appropriate ancillary cost center. If visit is made simultaneously by two or more persons from the home health agency to provide a single service, for which one person supervises or instructs the other, it is counted as one visit (see Example 1). If one person visits the patient's home more than once during a day to provide services, each visit is recorded as a separate visit (see Example 2). If a visit is made by two or more persons from the home health agency for the purpose of providing separate and distinct types of services, each is recorded--i.e., two or more visits (see Example 3). (i) Example 1. If two nurses visit the patient together to provide nursing services and one is there to supervise the other, one visit is counted.

(ii) Example 2. If a nurse visits the patient in the morning to dress a wound and later must return to replace a catheter, two visits are counted. However, if the nurse visits the patient in the morning to dress a wound and to replace a catheter, one visit is counted.

(iii) Example 3. If a nurse visits the patient to replace a catheter and at the same time the patient is visited by a home health aide to provide home health aide services, two visits are counted.

(4) Data source. Departmental records.

(5) Effective date. Reporting periods beginning in 1980 and thereafter.

(l) 6930 HOME HEALTH SERVICES--HOME HEALTH AIDES (1) Function. Home Health Aides Services is the provision of personal care services under the supervision of a registered professional nurse and, if appropriate, a physical, speech or occupational therapist or other qualified person. This function is performed by specially trained personnel who assist individuals in carrying out physicians' instructions and established plans of care. Additional services include, but are not limited to, the following: assisting the patient with activities of daily living (helping to bathe, to get in and out of bed, to care for hair and teeth, to exercise, to take medications specially ordered by a physician which are ordinarily self-administered); assisting the patient with necessary self-help skills.

(2) Description. This cost center contains the direct expenses incurred in the provision of Home Health Aide services. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services and other direct expenses.

(3) Standard Unit of Measure: number of home visits. A home visit is a personal contact in the place of residence of a patient made for the purpose of providing a service by a member of the staff of the home health agency or by others under contract or arrangement with the home health agency. Visits by therapists are not included here but in the appropriate ancillary cost center. If visit is made simultaneously by two or more persons from the home health agency to provide a single service, for which one person supervises or instructs the other, it is counted as one visit (see Example 1). If one person visits the patient's home more than once during a day to provide services, each visit is recorded as a separate visit (see Example 2). If a visit is made by two or more persons from the home health agency for the purpose of providing separate and distinct types of services, each is recorded--i.e., two or more visits (see Example 3).

(i) Example 1. If two nurses visit the patient together to provide nursing services and one is there to supervise the other, one visit is counted.

(ii) Example 2. If a nurse visits the patient in the morning to dress a wound and later must return to replace a catheter, two visits are counted. However, if the nurse visits the patient in the morning to dress a wound and to replace a catheter, one visit is counted.

(iii) Example 3. If a nurse visits the patient to replace a catheter and at the same time the patient is visited by a home health aide to provide home health aide services, two visits are counted.

(4) Data source. Departmental records.

(5) Effective date. Reporting periods beginning in 1980 and thereafter.

(m) 6990 HOME HEALTH SERVICES--OTHER HOME HEALTH (1) Description. This cost center is used to report home health patient care services not specifically required to be reported in Home Health--Skilled Nursing Care (account 6910), Home Health--Medical Social Services (account 6920) and Home Health Aides (account 6930). Such services include nutritional services, homemaker services and private duty nursing. The cost of therapy services such as physical therapy, speech-language pathology, occupational therapy and respiratory therapy must be reported in the appropriate ancillary cost centers. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services and other direct expenses.

(2) Standard Unit of Measure: number of home visits. A home visit is a personal contact in the place of residence of a patient made for the purpose of providing a service by a member of the staff of the home health agency or by others under contract or arrangement with the home health agency. Visits by therapists are not included here but in the appropriate ancillary cost center. If visit is made simultaneously by two or more persons from the home health agency to provide a single service, for which one person supervises or instructs the other, it is counted as one visit (see Example 1). If one person visits the patient's home more than once during a day to provide services, each visit is recorded as a separate visit (see Example 2). If a visit is made by two or more persons from the home health agency for the purpose of providing separate and distinct types of services, each is recorded--l.e., two or more visits (see Example 3). (i) Example 1. If two nurses visit the patient together to provide nursing services and one is there to supervise the other, one visit is counted.

(ii) Example 2. If a nurse visits the patient in the morning to dress a wound and later must return to replace a catheter, two visits are counted. However, if the nurse visits the patient in the morning to dress a wound and to replace a catheter, one visit is counted.

(iii) Example 3. If a nurse visits the patient to replace a catheter and at the same time the patient is visited by a home health aide to provide home health aide services, two visits are counted.

(3) Data source. Departmental records.

(4) Effective date. Reporting periods beginning in 1980 and thereafter.