decisionhealth Newsletters, Answer Books - 2006 Issue 7 (July)
Medicare_Claims_Processing_Manual / Chapter_8 / 60.3
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Article Overview
This article explains Medicare billing and payment guidance for blood and blood services furnished in hospital-based and independent dialysis facilities. It covers the relationship of these services to the composite rate, payment handling for different facility types, HCPCS-based reporting for blood bank services, and the use and reporting of local procedure and modifier codes. The material is relevant to dialysis facility billers, hospital outpatient billing staff, and Medicare contractors responsible for charge determination and code maintenance.
Why This Topic Matters
Blood-related services in dialysis settings can be paid and reported differently from other dialysis services, so understanding this guidance helps facilities and contractors distinguish composite-rate items from separately payable items and align billing with Medicare manual instructions.
Article Sections
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Blood and Blood Services Furnished in Hospital Based and Independent Dialysis Facilities
Overview of Medicare policy for blood-related services in dialysis settings, including payment considerations for hospital-based and independent facilities and related billing references.
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Billing Entries related to blood
Discussion of how blood bank services are reported using HCPCS codes, how grouped charges may be reflected, and how contractors may establish local code support for facility billing.
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Supplies and local code reporting
Information on reporting supplies with revenue code 0270 and on contractor responsibilities for local code definitions, billing frequency, and submission to CMS and regional offices.
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NOTE
Administrative note about deletion timelines for certain local procedure and modifier codes and a reference to guidance on temporary national codes.
What You Will Learn
- How Medicare manual guidance addresses blood and blood services in dialysis facilities
- How payment handling differs between hospital-based and independent dialysis facilities
- How blood bank-related services are reported using HCPCS and local codes
- What administrative reporting and deletion guidance is included for local procedure and modifier codes
Who Should Read This
- Dialysis facility billing staff
- Hospital outpatient billing departments
- Medicare contractors
- Revenue cycle professionals
- Coding and charge description masters (CDM) staff
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