Health Information Management

Q&A: Bill blood administration the same way for inpatient and outpatient accounts

APCs Insider, October 3, 2008

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QUESTION: I just heard a fiscal intermediary clearly state that they expect hospitals to bill blood administration on inpatient accounts the same as it is billed on outpatient accounts. Is this correct?

ANSWER: Yes: TriSpan and other FIs and MACs are confirming that hospitals should bill blood administration on inpatient accounts just as they do on outpatient accounts. CMS discusses this in the August 19, 2008 IPPS Final Rule 73 FR 48465. View the last column continuing on to p. 48466.

The rule states:

because blood transfusion and blood products are not specifically mentioned in the definition of ‘routine services’ in the PRM-1 under Section 2202.6, or in the definition of ‘ancillary services’ in Section 2202.8…if the provider does not impose a separate charge in addition to the routine service charge, the service is considered not to be ancillary.

In other words, hospitals are free to create a separate charge for blood administration to inpatients when provided to patients in routine cost centers. They are expected to do so whenever blood is administered in an ancillary department, such as the emergency department, operating room, or infusion center. This step separates the blood administration service from the routine cost center and follows longstanding CMS rules that providers should consistently follow their customary charging practice for all patients, regardless of whether they are an inpatient or an outpatient.

CMS discusses the importance of charging all services consistently between inpatients and outpatients throughout the IPPS Final Rule. The importance will become more apparent as CMS continues its educational efforts on cost reporting and charge practices.



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Comments

2 comments on “Q&A: Bill blood administration the same way for inpatient and outpatient accounts

CM (11/30/2012 at 11:39 AM)
Did anyone ever answer this question for you? I am wondering the same thing. Thank you.

 

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