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Blood Administration charge

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How is everyone handling this once per day charge at your facility? Personally, I believe this charge should be generated by the area performing the transfusion. For inpatients, it probably doesn't matter much. I was at a seminar where it was suggested it could be incorporated into the daily nursing care charge for inpatients. We have been expected to tag the charge onto each blood product and then write an edit so that only one charge per patient per day gets billed. Then the outpatient transfusion charge revenue has to be credited back to the outpatient infusion area. Lab computer systems not being robust billing systems, the edit doesn't always work. Now we are being audited for overcharges. I am hoping to use this as my argument for placing the responsibility for transfusion billing on the areas performing the transfusion.

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It is a Nursing Dept. responsibility. They also should get the funny money that goes with the charge.

BC

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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.

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We were just instructed by our billing consultants and our Revenue Mgt dept that it is allowable to enter this charge on an inpatient account. Our OP tx center has done this themselves forever, our IP nursing staff is "too busy" to enter this charge so the BB does it.

We print a tx listing from our BB system and do the IP charge manually and we get the "revenue" in the BB. Prior to entering the charge we view the pt account to make sure we don't double charge this fee. It takes us less than 10 min to do it daily, 400 bed Level II trauma center.

Next time the wind changes direction we will probably d/c entering this charge.:surrender

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At our facility the nursing department enters the charge. Billing department will contact me when they have a charge on a patient, but there are not blood products associated with this, mostly due to outpatient patients are tested and the patient now needs a transfusion and is admitted for the transfusion.

Yes in-patients charges are bundled into DRGs etc, however, you still need to charge for every avialable procedures, materials, servcices renddered, room charges, medications etc. or CMS will not have this information to correctly reimburse for the DRGs. This has been a huge reason why the reimbursement for DRGs does not reflect the actual costs.

This was addressed extensively at the AABB convention that we all need to charge correctly for every chargable/billable item or service we provide even if we are still only paid a set price for a particular admission ,so that all the costs are appropriately captured and will then be caputred as actual costs for each admission and be used as the basis of future reimburse ment, whether that is an increase or decrease.

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Hi Bev,

We put this responsibility squarely in nursing, where it belongs.

We have an electronic medical record, both in-patient and out-patient, and it is generated by that system when the nurse documents transfusion. I'm not sure how they figure it's the first unit.

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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.

Where did you get the information that you can't bill this for inpatients, but you can for surgery? This is exactly opposite what I was told by a billing consulting firm our hospital hired.

Out Transfusion Service/BB does not enter these charges, nursing does. Though I could see that having a good way to link this charge to units issued and transfused could make it easier for everyone involved.

Linda Frederick

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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

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We have Meditech, our LIS person has it so it automatically charges for one unit administration per 24 hours no matter how many units are actually transfused, and the revenue goes to the nursing unit where it was administered. So neither BB nor nursing have to do anything.

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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.

Thanks for the reference to the Federal Register. It also adds,

"the provider must consider the established practice of the same class of providers in the same State as to whether to include blood transfusion in the routine service charge (for both Medicare and non-Medicare patients)."

Other places in the CMS regulations it talks about routine services being those that are provided routinely to all patients. Transfusion doesn't fit that description.

So I guess that things aren't the same everywhere. Too bad we can't be consistent and the regulations are not written more explicitly. That's why I am glad that other people make these decisions and not me!

Linda Frederick

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On 5/27/2009 at 10:03 AM, ANORRIS said:

We have Meditech, our LIS person has it so it automatically charges for one unit administration per 24 hours no matter how many units are actually transfused, and the revenue goes to the nursing unit where it was administered. So neither BB nor nursing have to do anything.

ANORRIS...I know this post is old, but we have Meditech and would like to build a similar rule. Could you help me get in contact with your LIS person? Your help is greatly appreciated! Once you reply I can give you my contact info. 

Thank you!

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On 5/27/2009 at 10:03 AM, ANORRIS said:

We have Meditech, our LIS person has it so it automatically charges for one unit administration per 24 hours no matter how many units are actually transfused, and the revenue goes to the nursing unit where it was administered. So neither BB nor nursing have to do anything.

ANORRIS...I know this post is old, but we have Meditech and would like to build a similar rule. Could you help me get in contact with your LIS person? Your help is greatly appreciated! Once you reply I can give you my contact info. 

Thank you!

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