Billing and Reimbursement for a Bedside Toxicology Service at a Tertiary Care Academic Center During Its First Fiscal Year

Abstract

A bedside toxicology consult service may improve clinical care, facilitate patient clearance and disposition, and result in potential cost savings for poisoning exposures. Despite this, there is scant data regarding economic feasibility for such a service. Previously published information suggests low hourly reimbursement at approximately $26.00/h at the bedside for toxicology consultations. A bedside toxicology consultant service was initiated in 2011. Coverage was available 24 h a day for 50 out of 52 weeks. Bedside rounding on toxicology consult patients was available 6/7 days per week. The practice is associated with >800 bed teaching institution in a large upstate NY region with elements of urban and suburban practice. Demographic and billing data was collected for all patients consulted upon from July 1, 2011 to June 31, 2012. In charges of $514,941 were generated during the period of data collection. Monthly average was $42,912. Net reimbursement of charges was 29 % of overall charges at $147,792. In terms of total encounters, net collection rate in which something was reimbursed or "paid" against charges for that encounter was 82.6 % of all encounters at 999/1,210. Average encounter time for inpatients, including critical care, was 1.05 h, and the average time spent for outpatients was 1.18 h. Reimbursement rates appear higher than previously reported. Revenue generated from reimbursement from toxicology consultation can result in recouping a substantial portion of a toxicologist's salary or potentially fund fellowship positions and salaries or toxicology division infrastructure.

Telemedicine Delivery and Successful Reimbursement in Toxicology

“…Previous work regarding billing and reimbursement for inperson toxicology consultation services has suggested lower levels of reimbursement with rates of charge and collection being as low as $66/h and $26.19/h respectively [14] in one study and our previously published work has shown a maximum reimbursement of $167.7/h for certain CPT codes related to bedside consultation [15]. However, our current data would suggest a telemedicine consultation billing and reimbursement profile that could exceed these values by a range of 122-778% depending on the specific nature of the encounter, time involved, and geographic payer mix.…”

Scoping Review of Interventions Associated with Cost Avoidance Able to Be Performed in the Intensive Care Unit and Emergency Department

“…A toxicology drug information consultation is defined as any DI consult pertaining to toxicology. A single‐center study described the first year of a bedside toxicology consultant service provided by a single board‐certified toxicologist in an academic medical center . Median charges per patient were $385.62 in 2012 U.S. dollars that included billing for inpatient and outpatient consultation and critical care time among other Current Procedural Terminology codes.…”

“…A single-center study described the first year of a bedside toxicology consultant service provided by a single board-certified toxicologist in an academic medical center. 77 Median charges per patient were $385.62 in 2012 U.S. dollars that included billing for inpatient and outpatient consultation and critical care time among other Current Procedural Terminology codes. Interventions by pharmacists related to toxicology that do not involve a toxicology consultation service would resemble these costs, especially because outpatient consultations resulted in lower overall charges compared with ED and ICU consultations; therefore, a conservative value is being used.…”

The Feasibility and Acceptability of Google Glass for Teletoxicology Consults

“…Importantly, a simple, unobtrusive HMD such as Glass has the potential to generate revenue (using comparable billing codes used by telestroke services to generate income) that may be applied to toxicology faculty support. Teletoxicology consults can increase the number of bedside consultations for fellows in training, decrease the reliance of fellowship programs on poison control centers, and improve the care of poisoned patients [12,3,13]. By placing an expert at the virtual bedside, Glass can provide additional exposure to a toxicology service with concomitant increases in educational opportunities.…”