If you DO NOT currently submit claims for the time your professionals (nurse, home health expert, etc) spend providing infusion therapy when in the patient home:
You don't have to take any action, and you can stop reading!
What's going on?
Home Infusion is under a massive change when it comes to billing for professional services. CMS is changing who can be accredited to bill for these services, the scope of documentation, and fees.
This does not impact providers of infusion pumps & equipment, or infusion drugs, unless your company provides those things and also bills for the time the nurse is physically in the home. To bill these, you would be submitting single day units with G Codes. (G0068, G0069, G0070)
YES, I currently bill for Home Infusion Therapy (HIT) professional services:
Here's what you need to know:
- 2019 & 2020 are called temporary or transitional benefit years for HIT.
- 2021 the permanent benefit for HIT goes into effect
- Your accreditation may already cover you, but probably best to check. (Ask existing Accreditation Org (AO) about Home Infusion Therapy certification)
- As of June 2019 you were required to be billing HIT to the A/B MAC's (local MACs). If you are not registered with the A/B MAC in your coverage area, get started!
- If you are not a member of NHIA, you need to change that. We find their counsel invaluable, and we think you will too. Click here to join.
- During the temp period (2019/2020) only Pharmacies enrolled as DME's can bill for HIT professional services.
- As of the permanent rule proposed for 2021 here is a break out of who can bill for what once you have all of the certifications in order:
- Plan of Care is the key piece of documentation you will need to support your claims, and must be periodically reviewed. Here are some basics about what a Plan of Care must include:
- Type of HIT
- Professional conducting onsite service
- signed by physician
- We do not have clarification yet on the time span for "periodic review" and we assume that HIT Suppliers will be able to draft the POC as they currently do for physicians to sign prescriptions.
- As of 2021. Home Health Agency's will not be able to provide infusion related services under the home health episode.
- G codes are billed in the ANSI 837 format to Part B benefits.
- Modifers are going to be very important, especially to designate between 1st visit and Subsequent Visits. As additional visits should only be billed when the provider can prove a need for nurse administered services in the home, we expect it would be rare to have dozens for billable visits for one patient in the same episode of therapy.
- A new 1st visit fee can only be billed after 60 days of discharge from HIT.
No, I don't currently bill for Home Infusion Therapy (HIT) professional services but I want to start:
- Find an Accreditation Organization (AO) to get started working on Home Infusion Therapy (HIT) certification.
- Start the process of registration with the A/B MACS in your service area, who are all managed by separate contracts and require an 855 form to be filled out.
- Join NHIA
- Get very clear on Plan of Care documentation requirements and how your system will support them.