Blog/ Hospital billing
What are the billing rules for bedside procedures?
Understand the CBHPM conditions that allow physician fees to be valued at double when care takes place in superior accommodations or intensive care units by the patient’s choice
- By
- Rivio, Editorial team
- Published
- Reading time
- 2 minutes
Do bedside procedures (ICU) entitle the physician to a doubled fee in the payout?
Rivio answers
According to the Brazilian Hierarchical Classification of Medical Procedures (CBHPM), if a patient chooses to stay in a private room even though they are eligible for a ward bed, the physician fee may be doubled.
In this case, if the ICU where the patient stays is a private room, it is also possible to charge the doubled physician fee, as long as the patient made that choice before admission.
It is important to stress that this rule does not apply when ward beds are unavailable and the patient may be placed in a private room because of care needs. In these cases, charging the doubled physician fee is not allowed, even if the patient is treated in a private room.
This rule applies only to medical procedures and does not include imaging tests, for example.
You can check this passage in the CBHPM:
6. ADMISSION CONDITIONS
6.1 When the patient voluntarily chooses to be admitted to SUPERIOR HOSPITAL ACCOMMODATIONS, different from those provided for in item 1.5 of these Instructions and from what is provided for in their original health plan, the valuation of the tier (tier) for the procedures will be supplemented by negotiation between the patient and the physician, with item 6.2 of these Instructions serving as a reference.
6.2 For superior plans offered by payers, unlike what is provided for in the aforementioned item 1.5, the tier is valued at double its quantification in the case of patients admitted to an apartment or private room, to a “day hospital” or to an ICU. The medical acts in chapter IV (Diagnostic and Therapeutic) are not subject to the conditions of this item, except when provided for in specific notes in the chapter.
6.3 Any operational agreements between healthcare payers and hospitals may not reduce the quantification of the tiers established for the medical team, subject to the items above (6.1 and 6.2).
