What s in a Kit? A Supply Show and Tell to Facilitate Billing Accuracy

Transcription

1 What s in a Kit? A Supply Show and Tell to Facilitate Billing Accuracy Renee Hunt Vice President, Revenue Cycle Management Amerita and Janice Donovan, RN, BSN Regional Director of Nursing New England Life Care 2016 NHIA Annual Conference & Exposition 1

2 Speaker Disclosures The speaker(s) for this presentation have no conflicts of interest to disclose. Off label and/or investigational drug uses will not be discussed during this presentation NHIA Annual Conference & Exposition 2

3 HCPCS History Established in 1978 by the Health Care Financing Administration (HCFA) became Centers for Medicare and Medicaid Services (CMS) in NHIA Annual Conference & Exposition 3

4 HCPCS History HCFA The Healthcare Common Procedure Coding System (HCPCS, often pronounced by its acronym as "hick picks") is a set of health care procedure codes based on the American Medical Association's Current Procedural Terminology (CPT) NHIA Annual Conference & Exposition 4

5 HCPCS History Use was largely voluntary until enactment of Health Insurance Portability and Accountability Act (HIPAA) in 1996 made them mandatory NHIA Annual Conference & Exposition 5

6 Types of Supply Codes Medicare Supply Kits The only way to bill supplies prior to having HCPC codes for Per Diems Per Diems Not necessary to distinguish supplies since one code encompasses all NHIA Annual Conference & Exposition 6

7 Per Diems Specific to therapy / frequency / route of administration Doesn t matter what items are listed on the Delivery Ticket NHIA Annual Conference & Exposition 7

8 Per Diems True definition of the codes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately) Definitions may also be found at NHIA Annual Conference & Exposition 8

9 Per Diems REAL definition of the codes All supplies you send out will be considered under the per diem code so be careful and don t break the bank while still taking care of your patient NHIA Annual Conference & Exposition 9

10 Medicare Supply Kits REAL definition of the codes All supplies you send out will be considered under the supply code so be careful and don t break the bank while still taking care of your patient Sound familiar? NHIA Annual Conference & Exposition 10

11 Great idea to send all the supplies needed to take care of your patient! NHIA Annual Conference & Exposition 11

12 Not a good idea to overstock! NHIA Annual Conference & Exposition 12

13 Medicare Supply Kits For purposes of this presentation, we will be looking at the supply kits related to these Medicare Local Coverage Determinations (LCD) External Infusion Pumps Enteral Nutrition Therapy Total Parenteral Nutrition Therapy NHIA Annual Conference & Exposition 13

14 Infusion Pumps NHIA Annual Conference & Exposition 14

15 External Infusion Pump A4221 Supplies for Maintenance of drug infusion catheter, per week Includes but not limited to: Dressing Change Kits Alcohol Swabs Gauze Caps Tubular Dressing Tape Flushes NHIA Annual Conference & Exposition 15

16 A4221 Dressing Change Tray or Kit Gauze Sponges NHIA Annual Conference & Exposition 16

17 A NHIA Annual Conference & Exposition 17

18 External Infusion Pump A4222 Infusion supplies for external drug infusion pump, per cassette or bag Includes but not limited to: Administration Sets / Tubing Filters Extension Sets IV Pole extenders Batteries NHIA Annual Conference & Exposition 18

19 A NHIA Annual Conference & Exposition 19

20 A NHIA Annual Conference & Exposition 20

21 Enteral Nutrition Enteral Feeding Pumps Enteral pumps available with feed and flush capabilities These pumps are portable and can fit into a backpack Schedule can be customized to meet patient s therapy and quality of life goals Medical necessity must be documented in order for enteral pumps and supply kits to be covered NHIA Annual Conference & Exposition 21

22 Enteral Feeding Pumps NHIA Annual Conference & Exposition 22

23 Enteral Nutrition B4034 Enteral Feeding supply kit; syringe fed per day B4035 Pump fed, per day MEDICAL NECESSITY MUST BE DOCUMENTED FOR THE PUMP B4036 Gravity fed, per day Includes but not limited to Feeding / flushing syringe Administration set tubing Dressings Tape NHIA Annual Conference & Exposition 23

24 Enteral Nutrition Kits do not include the following: Nasogastric Tubes (B4081 B4083) Gastostomy / Jejunostomy (B4087 B4088) Tubes are billed separately and no more than three are allowed in a three month period NHIA Annual Conference & Exposition 24

25 Enteral Nutrition Supply allowance HCPCS codes (B4034 B4036) are daily allowances which are considered all inclusive and therefore refill requirements are not applicable to these HCPCS codes. Refer to the Coding Guidelines section in the Policy Article for further clarification. Current Local Coverage Determination NHIA Annual Conference & Exposition 25

26 B4034 B4035, B NHIA Annual Conference & Exposition 26

27 Enteral Supplies NHIA Annual Conference & Exposition 27

28 TPN B4220 Parenteral nutrition supply kit; premix, per day B4222 (rarely used) Parenteral nutrition supply kit; home mix per day Includes but not limited to: Tape Gauze Alcohol Swabs Syringes Empty Bags NHIA Annual Conference & Exposition 28

29 B4220, B NHIA Annual Conference & Exposition 29

30 TPN B4224 Parenteral nutrition administration kit, per day Includes but not limited to: Administration sets / Tubing Extension sets Batteries Catheter Care Supplies Flushes NHIA Annual Conference & Exposition 30

31 B NHIA Annual Conference & Exposition 31

32 DO s and DON TS of Other Payers For our purposes, Other Payers are those that are not mainstream or those not defined in the contract. For example: LOA agreements Bob s HMO NHIA Annual Conference & Exposition 32

33 Others DON T ask if they bill by Medicare guidelines this is open ended and can result in a multitude of answers DO ask if they accept S codes or if they utilize A and B codes NHIA Annual Conference & Exposition 33

34 Others Medicare guidelines may refer to: Criteria sets Coding Modifiers Documentation Narratives Often times dismissed as a difference in semantics until payment is not received NHIA Annual Conference & Exposition 34

35 Others DON T ask if they want line item billing DO ask if they accept S codes or if they utilize A and B codes NHIA Annual Conference & Exposition 35

36 Other Payers Line Item Billing If the payer requires HCPC codes, this does not translate into billing for every single item delivered Why? There are many different items with the supply kit codes assigned in inventory files They really don t want true line item billing if they know their codes NHIA Annual Conference & Exposition 36

37 Exhibit Hall Navigational Tool For Hands on Exploration of Supply Kit Contents NHIA Annual Conference & Exposition 37

38 Questions? NHIA Annual Conference & Exposition 38