There is increased complexity in the provision, documentation, and billing of infusion services. Providers may be subject to False Claims Act violations and overpayment issues if they are not billing and coding services compliantly or implementing operational processes to ensure appropriate clinical supervision. With the increased cost of infusion drugs, providers may also face challenges and risks associated with the patient collections process.
Bass, Berry, & Sims recently hosted a webinar, “Billing, Coding, and Collecting for Infusion Services,” discussing the various compliance considerations related to the provision of infusion services and their associated billing and collections. PYA Consulting Senior Manager Carine Leslie and Consulting Manager Katie Garmon joined Shannon Wiley with Bass, Berry, & Sims as speakers during the event. They examined common coding and documentation errors and the importance of, and requirements related to, medical necessity and nursing supervision (i.e., start and stop, post-infusion monitoring, etc.). They also discussed advanced practice provider (APP) supervision.
Other topics they covered include:
- Coding and documentation requirements for therapeutic/prophylactic/diagnostic infusions and chemotherapy/other highly complex drugs.
- Documentation of quality to include physician order requirements, medication dosage, nursing documentation requirements, etc.
- Infusion supervision guidelines per Medicare and operational considerations.
- Patient collections for infusion drugs including co-pays, waivers, discount programs, etc.
- False Claims Act implications and overpayment law.
If you have questions about the provision of infusion services and their associated billing and collections, or any matter involving compliance, valuation, or strategy and transactions, one of our executive contacts would be happy to assist. You may email them below, or call (800) 270-9629.