CMS issued a new rule from CR 11880 that will be updated with the calendar year 2021 that prohibits beneficiaries from receiving the professional services associated with Part B infusion drugs under the home health benefit.
The Medicare home infusion therapy services benefit covers the professional services. This benefit also includes nursing services, patient training, education, remote monitoring, and monitoring services. The therapy services benefit would all be in accordance with the plan of care, and under guidelines the home infusion drugs must be furnished by a qualified home infusion therapy supplier.
Part B (home infusion drugs) are drugs administered intravenously for an administration period of 15 minutes or more, in the home of an individual through a pump that is an item of durable medical equipment.
The big question is, how do we make sure you can still do infusion therapy? In order for your agency to still bill for those services you must be approved by Medicare to be a Home Infusion Therapy Supplier. You do this by using form CMS 855-B. These services are to be billed on a CMS-1500. It is important to note that a single payment is made on the day the nurse is in the home and drug is infused.
There will be 6 G codes assigned to Part B infusion drugs. Each of these codes will need to be reported in 15-minute increments. These drugs will be assigned to three payment categories. They are determined by their J code counterparts. If there are multiple drugs from different categories made on the same day, one payment will be made that will be equal to the highest category. There will be a 30 day look back period for this J code.
NAHC confirmed that CMS will not be accepting applications from home health agencies until the HHPPS rule has been finalized. This will limit your time frame for enrollment.
CMS issued a new rule from CR 11880 that will be updated with the calendar year 2021 that prohibits beneficiaries from receiving the professional services associated with Part B infusion drugs under the home health benefit.
The Medicare home infusion therapy services benefit covers the professional services. This benefit also includes nursing services, patient training, education, remote monitoring, and monitoring services. The therapy services benefit would all be in accordance with the plan of care, and under guidelines the home infusion drugs must be furnished by a qualified home infusion therapy supplier.
Part B (home infusion drugs) are drugs administered intravenously for an administration period of 15 minutes or more, in the home of an individual through a pump that is an item of durable medical equipment.
The big question is, how do we make sure you can still do infusion therapy? In order for your agency to still bill for those services you must be approved by Medicare to be a Home Infusion Therapy Supplier. You do this by using form CMS 855-B. These services are to be billed on a CMS-1500. It is important to note that a single payment is made on the day the nurse is in the home and drug is infused.
There will be 6 G codes assigned to Part B infusion drugs. Each of these codes will need to be reported in 15-minute increments. These drugs will be assigned to three payment categories. They are determined by their J code counterparts. If there are multiple drugs from different categories made on the same day, one payment will be made that will be equal to the highest category. There will be a 30 day look back period for this J code.
NAHC confirmed that CMS will not be accepting applications from home health agencies until the HHPPS rule has been finalized. This will limit your time frame for enrollment.
Want to prepare? Call SMART today to get this process started for your agency.
