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Four missed billing opportunities in home infusion

Written by: Mediware Bloggers on Monday, October 30, 2017 Posted in: Home Infusion

By: Kathy Wright, Mediware Reimbursement Services

In today’s home infusion market with fee schedules slashed, recognizing all possible revenue opportunities and ensuring they are billed is critical to turning a profit. Although most software systems can help automate home infusion billing, there are many exceptions to the rule where an experienced biller may spot additional revenue opportunities that might otherwise go unaddressed and thus unbilled . To avoid missing costly revenue opportunities, check out our tips below.

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Billing for equipment in kit format

Since most home infusion claims are billed in a per diem format using S codes, the equipment (enteral feeding pumps, ambulatory pumps, IV poles, etc.) itself isn’t typically separately billable.  Because of this, many providers do not take the time to set up the DME to generate monthly charges. Yet, when you are billing in a kit format, you can bill separately for rental items. While billing in a kit format is usually the exception, the rental for the pump can sometimes be the difference between being profitable or not on a particular patient. Without an automated process, billing employees have to remember to manually add equipment to claims. If you have not set up your equipment to generate charges,  you need to know that you can bill for the equipment after the fact, provided you’re still following the filing guidelines. It does not have to be on the same claim as the other items. It would be worth going back, evaluating which payers are billed in a kit format and performing an audit against billed claims. You are guaranteed to identify some lost revenue just waiting to be found.

Billing all drug quantities for single dose vials

When providing single-dose or single-use vials, like Cubicin or Milrinone, patients often do not require the entire vial, which leaves you with leftover, wasted medication. In these situations, if the extra medication is not being used you can (and should) bill for the entire vial unless the specific payer contract specifies that you can only bill for the exact amount used for the patient. Your billing staff should know the billed amount per vial of all single-dose drugs.  If you have not done this already, mark the drugs with the acronym “sdv” in your software system. This way, you can capture the amount not included in the patient’s actual prescription and add it to the corresponding claim.

Billing for flushes and diluents

Despite the NHIA National Coding Standard for Home Infusion mandate that all drugs be billed separately, many payers operate under their own sets of guidelines. For example, including flushes and diluents in per diem reimbursement claims is commonplace in many payer contracts. If bundling of flushes and diluents in per diem claims is routine for your staff, adjust your practices to comply with the NHIA standard–unless the payer contract specifically requires it. Unless your contract specifies, you won’t know if your “ancillary” drugs are payable unless you try to bill for them. Additionally, sometimes items that are included in the per diem are billable in some specific circumstances or for some therapies. Sodium Chloride, for example, could be considered a diluent and included in the per diem; but it could also be the primary drug (thus billable) for hydration therapy.  Make sure your billing staff understands these important details or you will not capture all of your billable revenue.

Billing for “gap” per diems

A gap per diem is a period of missing billable days between a patient’s billed claims. At Mediware Reimbursement Services, our practice is to check the most recent billed claims to ensure there’s no overlap in the per diem dates but also to ensure there is no (unaccounted for) gap in per diem days. For example, if a patient receives enteral services, with the last invoice dated September 5 and the next starting on September 10, there’s a gap in billing from September 6 to September 9. While there are some cases in which you can’t bill, like if the patient required hospitalization, most scenarios allow for billing during the gap. This is because, usually, the patient didn’t consume the allowed amount of formula, which prolonged the period between deliveries. Because the patient still uses the formula during the gap, these days are billable.

With home infusion reimbursement rates at an all-time low, your billing staff must capture every opportunity. By closely reviewing all payer contracts, you can ensure potential revenue opportunities are not missed. Our trusted team at Mediware Reimbursement Services can help you bill correctly the first time. With more than 20 years of experience in home infusion, our proven results can grow your revenue and profit margins and lower bad debt.


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