Overview
Accurate billing and reimbursement reflecting actual costs is critical if patients are to receive the best possible blood products, transfusion services and cellular therapies. Because a large percentage of these products and services are covered by Medicare effective communication with the Centers for Medicare and Medicaid Services — the federal agency that administers this program — as well as with the U.S. Congress — which directs many changes to the system — is critical.

AABB is committed to seeking enhanced and fair reimbursement for blood products, transfusion services and cellular therapies through both education regarding the complexities of coding and billing and advocacy to relevant policymakers. AABB serves as a leading advocate before CMS and Congress for fair and timely Medicare reimbursement for blood products and services and cellular services. The association focuses on Medicare because it is by far the most significant payer for blood-related care, and its coverage and payment policies serve as an example for many other insurers. In the inpatient arena, where most blood is transfused, AABB and others in the blood community support the development and adoption of a new blood-related producer price index for calculating changes in costs for the goods and services hospitals use to provide inpatient care. Regarding outpatient reimbursement, AABB promotes improvements in the ambulatory payment classification system to ensure that it accurately reflects changing costs of blood and the increasingly complex array of blood products and services. AABB also supports improved Medicare reimbursement for bone marrow, hematopoietic progenitor cells and apheresis-related procedures as well as new or improved Current Procedural Terminology codes for transfusion and cellular therapy-related procedures.

Recent Actions

2008
7/18/08
CMS releases a proposed rule for the 2009 Hospital Outpatient Prospective Payment system.

5/2/08
CMS publishes an updated guidance regarding billing for blood and blood products (Transmittal 1495).

4/30/08
CMS releases the proposed rule for the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 with a suggested increase of almost $4 billion to hospitals that are part of the system.

Archived Actions

2007
11/27/07
CMS releases the final hospital outpatient prospective payment system rule detailing the 2008 payment rates for blood and transfusion, bone marrow and hematopoietic stem cell-related services.

9/12/07
Concerned over proposed payment levels for bone marrow and stem cell processing procedures as well as leukocyte-reduced red blood cells, AABB submits comments to CMS regarding proposed 2008 rates under the hospital outpatient prospective payment system.

9/6/07
AABB testifies before the Advisory Panel on Ambulatory Payment Classification Groups praising CMS' recent decision to recognize the current procedural terminology codes for stem cell and bone marrow processing while emphasizing that proposed payments under the hospital outpatient prospective payment system do not reflect actual costs associated with the procedures.

8/02/07
CMS publishes proposed rule for 2008 payments under Medicare’s hospital outpatient prospective payment system, including modest payment increases for most blood products and payments for newly recognized cellular therapy procedure codes. 
 
5/9/07
In an effort to improve reimbursement to patients involved in clinical trials, AABB submits a response to CMS concerning its proposed revisions to the Medicare National Clinical Research Policy.

2006
10/10/06
AABB submits comments on Medicare’s 2007 Hospital Outpatient Prospective Payment System proposed rule, urging CMS to increase its proposed payment of only $177 for leukocyte-reduced red blood cells, the most frequently transfused component.

9/26/06
CMS responds to AABB inquiry regarding appropriate billing for blood and related services and inquiry seeking clarification to CMS Transmittal 496 (March 4, 2005).
 
7/26/06
In a letter, AABB urges CMS to improve Medicare payments for bone marrow and peripheral blood progenitor cell processing services to reflect the actual costs of providing potentially life-saving care.