We have an on going debate about antigen charges in our blood bank.  We are currently only charging for an antigen typying ONE time. 

 

For example:  Patient A has and Anti-K.  We screen 2 units and the patient A is billed for 2 antigen typings.  Patient A does not use the units and they are released.  Patient B has an Anti-K and needs K negative units.  The same K negative units are crossmatched on patient B.  We currently are not charging patient B for the antigen typings.

 

We are not interested in overcharging a patient, but they do have a special requirement (e.g.  sickle negative and cmv negative).

 

Please advise,

 

Sharon Stradley

I agree with your billing procedure.

We charge both patients. It's the patient who has the requirement and the order.

If we only did the antigen typing once, we charge the first patient, whether or not they end up using them.  We wouldn't charge the second patient for getting a product already antigen typed.

For those of you you only charge the first patient, how do you efficiently keep track of when that unit was charged?  I could see missing a lot of charges this way. Very few techs ever enter the charges at my facility, leaving that responsibility to the Lab Manager and myself.  We usually retroactivily enter those charges a day or two later.  I can't imagine how I'd be able to definitively recall if the antigen typing on those units had already been charged to another patient.

To not miss charges, my last place of employement had each tech fill out an antigen charging worksheet. This worksheet included patient name, how many antibodies the patient had, how many units were screened to find the required amount and thus the total amount to charge for. We then put it in a folder for the charge tech to enter in later, and possibly save for a period of time to know the charge was taken care of for patient A. We would not double charge the work if patient A did not use and patient B ended up being the one to use the units.

I guess we're in the minority so far, has anyone ever discussed this with their billing compliance team or know of official guidelines?

The idea of charging a patient for something that they didn't even receive, then turning around and giving it to a different patient for free seems very bizarre..

I am really interested in the billing compliance guidelines for this antigen typing debate.

We charge both.

We only charge for the first typing, but I will be checking with billing compliance.  We have antigen typing worksheets that I go through and charge for patients.

I agree with Goodchild. We also charge both patients.

We charge both patients.

We charge both patients.

 

The way I look at it is patient #1 with an antibody requires the antigen charge so the unit is ready in case they need it. They didn't use it so it goes back on the shelf when the crossmatch expires. Patient #2 comes in and needs antigen negative units. We use the units that are already antigen typed and charge patient #2 for the antigen typing. If I had pulled a random unit off the shelf that was not antigen typed, I would have had to perform the testing and charge the patient. I have to provide antigen negative units for both patients whether they use them or not. It is to our benefit (and a blessing) that a unit was sitting there ready to be used.

 

If you only charge the first person, what do you do when you antigen type several units and find extra antigen negative units. You can't charge the first patient for the extra units. It sounds like you wouldn't charge the second one either. I see missed charges and a lot of confusion.

There was an AABB teleconference a couple of years ago with Suzanne Butch on coding, reimbursement and charges, and I believe she said not to bill for the second patient. I think the rationale was that the test had already been performed and your costs billed for the first time. You did not perform another test for the second patient. We use a sticker system for keeping track of what's been billed: a green "Antigen Negative" sticker (with the specificity listed) at the top of the bag if billed, a red "E-negative" etc label for the extra unbilled units. If patient #2 comes along, we won't bill again for a green sticker but will for a red one. All the typing results are in the LIS anyway, but having the stickers makes it very easy at a glance to see if units have already been screened, and already been billed.

 

AABB has some stuff on their website but it is several years old.

I agree with the idea that they should only be charged once.  In our case, for the patient who they are first typed for.  Charging twice under any system would be billing more than once for a single test, which I am pretty sure is a no-no in any regulatory agencies' book.

 

Scott

I spoke with our front-line laboratory billing compliance associate. What they said was:

 

If you screen 2 units for K antigen for Patient A with anti-K, charge patient A.

If the units are subsequently transfused to patient B, patient A should be credited and the charges should be applied to patient B.

 

The reasoning is that you can't charge twice for a test but you also can't charge patient A for things for patient B. (or in some of our real world situations, theoretical patient C, D, E, etc).

 

I'm going to ask someone higher up the chain and see their thoughts.

This sounds way too confusing for me.  (Going back and crediting Patient A for antigen typings done a month ago??)  Sounds the personnel time to do the charging, tracking, & crediting might cost more than what you charge for the antigen typing.

We charge the first patient for the antigen typings. We do not charge the second patient. We also would not go back to credit the first patient. Blood was ordered for patient number 1 and we did what was required to provide that blood. It doens't matter if it was used or not....the order was there and the work was done.

Patient number 2 just got lucky this time!

We have a worksheet that we mark to make sure the typings have been charged.

If we grabbed 4 units to type for JKa and got lucky that all 4 were negative, we would charge the patient for all 4 typings.....even if they only needed one unit. We would not type our frig one unit at a time.....again, we are charging for what was required to provide blood at the time it was ordered.

I agree with Goodchild - we charge both patients.

There was an AABB teleconference a couple of years ago with Suzanne Butch on coding, reimbursement and charges, and I believe she said not to bill for the second patient. I think the rationale was that the test had already been performed and your costs billed for the first time. You did not perform another test for the second patient. We use a sticker system for keeping track of what's been billed: a green "Antigen Negative" sticker (with the specificity listed) at the top of the bag if billed, a red "E-negative" etc label for the extra unbilled units. If patient #2 comes along, we won't bill again for a green sticker but will for a red one. All the typing results are in the LIS anyway, but having the stickers makes it very easy at a glance to see if units have already been screened, and already been billed.

 

AABB has some stuff on their website but it is several years old.

I seem to remember the same being said at several reimbursement work shops at AABB meeting. I can't find it in writing.

Would appreciate any advice from a billing/compliance expert.  We charge both patients, though that doesn't seem quite right.  
I agree with Swede.

I was told by our billing compliance folks that we can only charge for the number of units ordered regardless of how many we screen to find the required units.  I would also like a definitive answer, because we end up doing a lot of these for free.

BankerGirl, I just hope you never have to screen for a Jk(a-b-) for a patient with anti-Jk3.  I reckon your establishment would go bankrupt!!!!!!!!!!!!!!!!!!!!!!!!

I was told by our billing compliance folks that we can only charge for the number of units ordered regardless of how many we screen to find the required units.  I would also like a definitive answer, because we end up doing a lot of these for free.

How long ago was that?  It used to be that way, but the last billing talk I went to through the Red Cross stated that you could use probability to bill for the number of units screened.  So you wouldn't expect to screen 10 to get 2 K-negative units, but you might screen 10 to get 2 little c or Jka-negative units.  Is that the way everyone else understands it?

When I spoke with our billing compliance person last week they told me that charging for positive antigen typings was acceptable provided that if we were audited, our practice would be seen within generally accepted practice standards and our documentation would support what we did.

e.g. Charging 6 antigen typings for a patient with anti-K who was ordered for 2 RBCs would seem suspect, but for a patient with anti-C that would make sense. We keep track of our in-house antigen typing on day of use worksheets so we'd be able to trace exactly what was done on whatever day for whatever patient.