rkirk

The Federal Register, year 2008, page 48466, and the paper-based Medicare Provider Reimbursement Manual, Pub 15, Part 1, section 2202, esp. 2202.6, Routine services "Included in routine services are the regular room, dietary and nursing services, minor medical and surgical supplies, medical social services, psych social services, and the use os certain equipment and facilities for which a separate charge is not customarily made. The Federal Register states it's o.k. to bill for transfusions in ancillary depts, such as ED, OR, etc.. Outpatients are not charged a room and board fee, so the charge includes the supplies that are not separately billable, the nursing time, etc. The deal is, if NURSING at the bedside is included in the room and board charge, and you charge for a blood transfusion, an IV fluid or medication administration, or any other nursing procedure done by nurses to the pateint while in that room, it is essentially double-billing. I am all for accounting for and billing for separately billable services, I worked with the charge master, in billing compliance and ethics and compliance for years. I just think it is not correct when an inpateint is being billed an IP room and board charge to also bill separately billable outpatient services as if the room and board charge does not include nursing services. I review all the bills that come into my house and don't want to pay anything that is not correct or properly represented. When we work for a Hospital or other healthcare provider, and that provider is double-billing for services, the charges (even if "bundled" into a DRG payment) have an impact on fees and reimbursement and affects every working Americans taxes and/or healthcare premiums. There's 2 sides to the coin

The 1 transfusion charge a day applies to OUTpatients. With inpatients, there is no blood transfusion charge if blood is administered by the nurses at the bedside in the pateint sroom, since th eroom and board charge INCLUDES all nursing services provided by hospital nurses provided at the bedside. IF the patient receives blood in surgery an it is administered by hosp staff (not the anesthesiologist, since they do their own billing), a charge can be assessed. In Dialysis, transfusion charges are bundled into teh hemodialysis procedure.

PammyDQ, that is great information and it makes sense! I have been doing on-line research, trying to find applicable regulations.

As a nurse reviewer, I agree with the comments that if you are doing it basically as a Quality control check and not medical necessity, most payers will not pay for a second test in that situation. I do have a question, though, it is standard practice to do repeated ABO/Rh testing on a patient who is in the Hospital? I see soem Hospitals only charge once, others charge EVERY TIME the patient is ordered ann RBC transfusion.

Thanks. This baby just came in the day before, and received 15cc RBC. I notice on subsequent days they only charge for the RBC aliquots. I think there must have been some sort of charging problem. Thanks for the advice, I'll check into that!

I am a nurse reviewer, and am reviewing a neonatal chart. The patient gets RBC aliquots, some days they bill for RBC Aliquots and splitting, some days they bill for the same as well as a unit of RBCs. It seems they should only bill for the Aliquot the pateint received, not the whole unit, as well. Am I correct or wrong? Thank you.