Anyone clear on the latest guidelines as to what can and can't be billed for FFP's/24 hr plasma and cryos which are thawed (pooled for cryo) which are not transfused. Thanks for your help.

I don't think you can bill for those. It might be called "fraud"!

I don't think you can bill for those. It might be called "fraud"!

I disagree. If you purchase a cucumber and it goes past expiry before you eat it, you still have to pay for it. You can't just return it and say 'I didn't use this so I want a refund'. Why should transfused products be any different.

The only exception I can see to this is if you have thawed units and they have been used on someone else. If someone has requested a thawing and the units have been wasted - they should pay.

For those of us in the USA:

Two quotes from a 2007 Reimbursement Guide focused on the Centers for Medicare and Medicaid Services (CMS) and published by the American Red Cross:

"Although hospitals may not bill for the cost of unused blood, it is appropriate to bill the costs of medically necessary processing or preparation services for unused blood related to a specific patient - for example, any medically necessary crossmatching - even if the blood ultimately is not transfused."

"......in situations where a unit of blood is irradiated specifically with the intent of transfusion to a beneficiary but is not transfused, the hospital may bill for the services of irradiating the unit of blood but may not bill for the blood product that was not transfused."

If anyone is aware that this has changed (or is aware whether private insurers will typically pay for unused blood products) please comment and share your info.

Donna

If a physician orders pooled CRYO5 for a patient, but does not transfuse, we bill the patient for a "thaw fee" X 5 and a "pool fee" X 1. You cannot bill for the productif the patient does not receive it, but you can recover the preparation charges. We do not bill for unused FFP (we give all our FFP a 5-day expiration and label as "thawed plasma"). We waste very little that way.

I disagree. If you purchase a cucumber and it goes past expiry before you eat it, you still have to pay for it. You can't just return it and say 'I didn't use this so I want a refund'. Why should transfused products be any different.

While I agree with your sentiments, it is still fraud to bill for any blood components not used by the patient. You can bill for thawing (and pooling) if the units are not used, but not the components themselves. I personally want to bill the Dr. or Nursing staff who ordered it unnecessarily, but the hospital won't let me do that either. Oh, well.

If a physician orders pooled CRYO5 for a patient, but does not transfuse, we bill the patient for a "thaw fee" X 5 and a "pool fee" X 1. You cannot bill for the productif the patient does not receive it, but you can recover the preparation charges. We do not bill for unused FFP (we give all our FFP a 5-day expiration and label as "thawed plasma"). We waste very little that way.

My understanding of billing agrees with this and Donna. Bill for testing, thawing and pooling, but not the product.

I personally want to bill the Dr. or Nursing staff who ordered it unnecessarily, but the hospital won't let me do that either. Oh, well.

Funny but I have had the same thought on more than one occasion!!

While we cannot actually "bill" the nurse/doctor for unused product, we do transfer the charge to the nursing area on paper so that they get the idea. Even if you can't do that, I would report this to the transfusion committee as a quality measure (number of products wasted due to inappropriate ordering practices). I also add these to our event reporting so they are on the quality department radar screen.

I agree with Julie. Report waste to every committee or manager that is relevant. Getting to the right ear can make a big difference. Sometimes you have to try several ears before you hit the right one.

We often bring O neg, uncrossmatched RBCs down to ER, but all are returned unused. Is there anything we can bill for this service?

You can bill for any testing that you performed that was associated with providing product - blood type, antibody screen, crossmatch, etc. but you can't bill for the product if unused.

I also would like to approach wastage in this manner but the powers-that-be won't let it happen. We do report wastage, esp plts, to our COO who can make tough decisions for/to/at the Medical Staff

. I personally want to bill the Dr. or Nursing staff who ordered it unnecessarily, but the hospital won't let me do that either. Oh, well.

We often bring O neg, uncrossmatched RBCs down to ER, but all are returned unused. Is there anything we can bill for this service?

Have you considered presenting data on how often this is wasted to the powers that be to see if the ordering practices can be modified? It takes time and effort to get movement, but often you can get at least some modification when you can show that a practice is wasteful. That hits the bottom line and CEOs are very attuned to the bottom line.

My best weapon is to point out any issue to my pathologist. If it is a cost issue he will ask for a gathering of supportive data and the issue will go to the appropriate committee and be addressed. Have had several issues adjusted by this method.