Health Information Management

Tip of the week: Bill the patient, not Medicare, for noncovered drugs

APCs Insider, March 28, 2008

You should not bill noncovered drugs to Medicare. Although it is true that hospitals do not receive a separate APC payment for packaged drugs, billing a noncovered drug to Medicare could cause compliance problems, even if the drug is packaged. In some cases, hospitals receive cost-based payments for outpatient claims. Cost-based payments are calculated based on total billed charges on the claim, including charges for packaged items and services. That means that if a hospital bills a noncovered drug as a covered charge, the hospital could end up getting additional money from Medicare for the noncovered drug even if the drug is packaged for OPPS purposes (assuming that the FI or MAC does not indicate that the drug charge is noncovered).

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