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Ensure proper billing when dispensing take-home drugs to patients CMS makes DMERC billing a requirement

HIM Connection, May 16, 2006

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Ensure proper billing when dispensing take-home drugs to patients
CMS makes DMERC billing a requirement

Starting July 1, 2006, hospitals must bill their durable medical equipment regional carrier (DMERC) for specific take-home drugs-including oral anticancer drugs, oral antiemetic drugs, and immunosuppressive drugs-and their associated supplying fees, according to the Centers for Medicare and Medicaid Services (CMS) Transmittal 882, "Hospital billing for take-home drugs."

Hospitals should also bill inhalation drugs and associated dispensing fees to their DMERC.

But according to Valerie Rinkle, MPA, revenue cycle director for Asante Health System in Medford, OR, and Susan Hull, MPH, RHIA, CCS, CCS-P, manager of coding products and services for the American Health Information Management Association in Chicago, hospitals should also consider two other major factors:

1. The transmittal essentially instructs hospitals never to dispense more than a one-day supply of a take-home drug to a patient. "Period-end of story," Rinkle says. "You can't bill for [more than a one-day supply] on a regular hospital bill."

   Traditionally, many hospitals send patients home with a two-day supply, Rinkle says. The classic example is when hospital staff discharge patients on a Saturday and give them a two-day supply of the drug to get them through the weekend. "Some hospitals still follow this out of habit," Rinkle says.

   However, don't follow this practice anymore, because the new transmittal states the following:

   Hospitals shall continue to bill their FI [fiscal intermediary] for outpatient services when the service includes an oral anticancer drug, oral antiemetic drug, or immunosuppressive drug so long as no more than one day's supply of a drug is given to the beneficiary.

2. If you do dispense more than one day's supply of the above drugs, you must bill them to your DMERC. If you don't have a DMERC supplier number, don't rush out and obtain one after you read this transmittal.

   Hull says most acute-care hospitals don't have a DMERC supplier number and don't need one because they dispense most of their drugs singly. And because applying for a DMERC provider number can be difficult and the reimbursement is typically low, Hull says most hospitals don't need to bother with DMERCs.

   Oral antiemetics are inexpensive, "literally a dime each," notes Hull. Oral anticancer drugs are more expensive and take-home inhalation drugs can be quite costly, "but unless your hospital dispenses a significant volume, you probably don't want to get involved with this because it's a whole new provider to deal with," she says. "Hospitals have insurance companies and FIs to worry about already."

This brings us back to the first point: If you don't have a DMERC supplier number and don't feel as though you need one, avoid dispensing multiple days of take-home drugs to patients because you won't get paid for them, Hull says.

Editor's Note: This article was adapted from the newsletter Briefings on APCs published by HCPro, Inc.

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