Billing Processing & Handling Fees

[krichards]

HELP! Are there any billing-proficient people out there?

My lab director wants to start billing a processing and handling fee for all our blood products transfused. However, our billing people seem to think this is not quite legit. I, of course, am just the person caught in the middle of this mess. I have a copy of the AABB Reimbursement Guide, but it does not list the proper CPT codes that the billing people say are required. I have not been able to find any additional information so far.

Is anyone doing this? If so, are you billing separately, or is it included in your product charge? If you are billing separately, what revenue code and CPT code are you using? Do you know of any resources that could better explain this to me?

I really appreciate any help!

[Lcsmrz]

The AABB has a billing guide on their site, under Programs and Services

[estiner]

Yes, you can bill for storage and handling fees but you have to add them to the cost of the product. At the 2007 AABB Coding & Reiumbursement seminar, it was recommended to raise the cost of your product by 2-3 times. Several other participants had already raised their prices 300% and it had gone through their Medicare personnel.

[krichards]

Thank you so much for the information! I have been beating my head against the wall with this one. Adding the charge to the product itself will definitely make things easier. The AABB Billing Guide is just not that explicit.

Thanks again.

[bbbirder]

You should go to CMS to get the details. If your supplier does not bill for the "blood" (and almost no suppliers do--if they bill for blood, they would have a replacement program), they are billing you for processing and that is all you can bill. You can set your price whatever you want. We keep platelets on hand, but have a plt restocking fee, that means our effective cost for platelets is really higher than what our supplier charges for one. Plus there are other costs, transportation, storage, depreciation on storage equipment, etc.

The HCPCS codes will depend on what products you use.

Go to Section 231 of this CMS document:

http://www.cms.hhs.gov/manuals/downloads/clm104c04.pdf

"When an OPPS provider furnishes blood or a blood product collected by its own blood bank for which only processing and storage costs are assessed, or when an OPPS provider procures blood or a blood product from a community blood bank for which it is charged only the processing and storage costs incurred by the community blood bank, the OPPS provider bills the processing and storage charges using Revenue Code 0390 (Blood Processing/Storage) or 0399 (Blood Processing /Storage; Other Processing and Storage), along with the appropriate blood HCPCS code, the number of units transfused, and the line item date of service (LIDOS). Processing and storage costs may include blood product collection, safety testing, retyping, pooling, irradiating, leukocyte-reducing, freezing, and thawing blood products, along with the costs of blood delivery, monitoring, and storage. In general, such categories of processing costs are not patient-specific. There are specific blood HCPCS codes for blood products that have been processed in varying ways, and these codes are intended to make payment for the variable resource costs of blood products that have been processed differently."

Linda Frederick

[Ann Viernes]

Here are some additional references from the Red Cross Reimbursement web site http://www.redcross.org/services/biomed/profess/reimbursement.html

See the attachments for the codes ("P" codes)

IPPSFinalRule for 2009.pdf

ReimbursementUpdateNov08.pdf

[Stoogiesfreak]

In our area, the majority of hospitals are charging for FFP and Thawing. Apparantly, the thought is now that FFP should have the thawing charge built in to the FFP charge. We have started to get rejections for thawing charges. So, we have removed the thawing charge and adjusted the FFP product charge to make up the difference. I have not seen anything formal from Medicare, but now the area hospitals are dropping the thawing charge and adjusting the FFP product charge.

According to the ARC billing people this is the correct interpretation of the rule. FFP thawing is assumed to take place since the product FFP is frozen. Good luck - I think the water is still a little murky on this one, but that seems to be the latest thoughts from ARC billing experts.

John

[Vic]

We charge a "Bill for Thawing" only if the unit is ordered and not transfused.

[tbostock]

Yes, you are allowed to charge a "thawing fee" if you thaw but don't transfuse, as Vic states above. However, if you are thawing and then transfusing it, you can only charge for the frozen product, not an additional thawing fee. You can increase the fee that you charge for frozen products accordingly to include any storage/processing fees, including thawing.

From the AABB website:

Question: Is the "thaw fee" still appropriate with FFP units?

Answer: The thaw charge (CPT 86927) should not be billed for thawed units of FFP or cryoprecipitate that are transfused. The HCPCS “P” code, as determined by Medicare, includes reimbursement for thawing these frozen components.

Reference

Medicare Claims Processing Manual Chapter 4, Section 231.6