Health Information Management

Tip of the Week: Bill all drugs separately, regardless of Medicare's reimbursement

APCs Insider, February 8, 2008

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Hospitals should separately report all drugs regardless of whether Medicare will pay separately for them. Be sure to report those charges with the dollar amount in addition to either the HCPCS code for the drug or a revenue code.

CMS did not issue any changes regarding the drug packaging threshold for 2008. It uses a threshold of $60 to determine whether it will establish separate payment for a drug or whether it will package the drug (i.e., the hospitals will not receive a separate payment). A hospital may administer a number of drugs for which it will not receive separate payment. However, Medicare has stated that it has packaged the drug charges into some other APC payment rates, and therefore the agency is reimbursing for the drugs-just not separately.

(The above tip was excerpted from the February issue of Briefings on APCs).



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