Congress Abstracts 2006

91

IMPLEMENTING NEW MEDICARE DOCUMENTATION/BILLING REQUIREMENTS AND CHEMOTHERAPY DEMONSTRATION PROJECT INTO PRACTICE. Sherry M. Wiedow, RN, OCN^®, and Darlene M. Pawlik Plank, RN, MSN, AOCN^®, Marshfield Clinic, Marshfield, WI.

The challenge for Oncology practices is how to provide accessible, high quality health care to patients in a cost-effective and efficient manner. 2005 changes in billing rules for medications and infusions created an opportunity to change practice support.

A committee was charged with the task of incorporating & implementing these changes by 1/1/2005. We recognized the following issues: increased nursing time to incorporate all changes in documentation, decreased patient contact, and increased risk of non-compliance. These issues prompted the creation of automated cues in the documentation process to meet the requirements & incorporate the demonstration project into practice.

Our documentation system includes the use of electronic templates. The template format is based upon the ONS Chemotherapy & Biotherapy Guidelines and recommendations for chemotherapy documentation. The templates can be customized by the nurse to document additional care, assessments or interventions.

Templates were created and/or revised to add the Centers for Medicaid and Medicare Services Demonstration Project (CMSDP) information and infusion start/stop times. The templates were made available to all Oncology nurses at 7 locations. Nurses were provided training on the function and use of the templates to support the new billing guidelines and the CMSDP.

Successful implementation of standardized templates for documentation increased documentation and charge accuracy without compromising the ability to easily adjust documentation to reflect deviations in clinical care.

Electronic templates enhanced accurate and meaningful documentation that supported hiring of positions to create accurate charges from nurse documentation and Pharmacy admixing records. Audits of the billing show high degree of accuracy. The templates are widely accepted and support the need for standardization of clinical practice when medical outcomes are not compromised. A standardized process for creating and revising documentation templates has been implemented.

The changes in billing for services and the CMSDP have required a review of how care is delivered, documented and billed. One can view this as a barrier to care or as an opportunity for systems improvement.