by Jared Staheli
June 25th, 2015
The IHS providers, including CAHs, are paid by the FI for covered drugs and biologicals provided during a covered inpatient hospital stay. All charges are combined and reported under revenue code 0100 (all-inclusive room and board plus ancillary) on TOB 11X.
Payment is made to IHS/tribal hospitals under IPPS. IHS CAHs are paid 101 percent of the all inclusive facility specific per diem rate.
The IHS providers are paid by the FI for covered drugs and biologicals provided during a clinic visit. All charges are combined and reported under revenue code 0510 (clinic visit) on TOB 13X (IHS/tribal hospitals and hospital-based clinics) or TOB 85X (CAHs). Payment is made to IHS providers under the AIR. Payment is made to IHS CAHs based upon 101 percent of the all inclusive facility specific per visit rate.
The IHS hospital swing-bed providers are paid according to the SNF PPS payment methodology for covered drugs and biologicals provided during the IHS hospital swingbed stay. Services are itemized and billed with the appropriate revenue code that describes the service on TOB 18X.
Payment to IHS CAH swing-bed providers for covered drugs and biologicals provided during an IHS CAH swing-bed stay is included in the all inclusive facility specific per diem rate.
Supply fees are also due when multi-day supplies of any of the following selfadministered drugs are provided to IHS hospital outpatients or patients of a providerbased clinic: oral anti-cancer drugs, oral anti-emetic drugs, or immunosuppressive drugs. Following the same procedures that apply to non-IHS facilities, these multi-day supplies must be billed to the appropriate DME MAC in order to collect the supplying fee. The supplying fee must be billed on the same claim as the drug itself. For a 1 day supply of the above mentioned drugs, there is no supplying fee, the facility bills the designated FI and is paid the AIR for the outpatient visit. For an IHS CAH, payment for a 1 day supply of the drug is based on 101 percent of the all inclusive facility specific per visit rate. Fiscal intermediaries will also make payment for multi-day supplies of these particular drugs when provided to a beneficiary in an inpatient Part B stay in an IHS hospital, CAH, or SNF.
For additional information regarding billing for drugs and associated supplying fees, see Chapter 17, §80.7 of Pub. 100-04, Medicare Claims Processing Manual.