AABB is committed to seeking enhanced and fair reimbursement for blood products, and transfusion services and cellular therapies through both education regarding the complexities of blood coding and billing, and advocacy to reimbursement policy makers.
Medicare Issues Final Rule for 2014 Hospital Outpatient Payments
AABB has prepared a summary of key sections of the 2014 proposed rule for the Medicare Hospital Outpatient Prospective Payment System of particular interest to the transfusion medicine and cellular therapy community. The rule includes relatively small decreases in payments for most frequently transfused blood products. Payments for transfusion services, apheresis and stem cell processing, as well as many blood processing codes, will increase substantially; however, these increases likely are due to new packaging of other services, especially laboratory tests. Provisions of the rule are effective January 1, 2014 unless stated otherwise.
Medicare Proposes New Packaging of Payments for Some Outpatient Products and Services in 2014
AABB has posted a summary of key sections of the 2014 proposed rule for the Medicare Hospital Outpatient Prospective Payment System of particular interest to members of the transfusion medicine and cellular therapy community. The proposed rule includes relatively small changes in payments for most blood products. However, the Centers for Medicare and Medicaid Services is proposing significant changes in the way many products and services – including some blood processing and transfusion and stem cell processing procedures – are packaged into ambulatory payment classifications, or APCs. Comments on the proposed rule are due to CMS by September 6, 2013, and provisions of the rule are effective January 1, 2014 unless stated otherwise.
Summary of 2013 Medicare Outpatient Payments for Blood Products and Transfusion and Cellular Therapy Procedures
AABB has prepared a summary of the 2013 Medicare Hospital Outpatient Prospective Payment System final rule, providing details about the payment rates for blood products and transfusion and cellular therapy services. The rule — issued in early November by the Centers for Medicare and Medicaid Services — calls for decreases in payments for several frequently transfused blood products and increased payments for transfusion and stem cell related services. Providers are urged to bill using the appropriate blood-related and stem cell processing codes so that CMS can obtain better cost data to help determine payments for these products and services in the future. The new payment system takes effect Jan. 1, 2013.
AABB Billing Guide
AABB's Billing Guide is intended to assist hospitals, clinicians, billing and coding professionals involved with the utilization and subsequent billing of the services and procedures associated with the use of blood and transfusion and cellular therapies. AABB produced this guide with the generous support and cooperation of the blood sector member companies of the Advanced Medical Technology Association (AdvaMed).
Many U.S. hospitals do not bill accurately, or at all, for blood transfused in the inpatient setting. Failure to bill appropriately for blood can hinder patient access to new technologies and potentially can affect the hospital's bottom line. The Billing Guide is intended to help hospitals bill accurately and completely for blood products and services. Though AABB does not provide any guarantees of reimbursement, the intent of this publication is to assist hospitals in understanding the billing rules and procedures that apply for Medicare and other payers.
The AABB Billing Guide is available below in PDF format for viewing and printing:
AABB Billing Guide – Version 4.0 (PDF)
AABB serves as a leading advocate before the Centers for Medicare and Medicaid Services (CMS) and Congress regarding the need for fair and timely Medicare reimbursement for blood products and services and cellular therapies. In the inpatient arena, AABB, along with others in the blood community, has supported efforts to allow Medicare to better account for the increasing cost of blood. In particular, AABB asked Congress and CMS to create a new blood-related producer price index (PPI) to be used in calculating the change in prices for goods and services hospitals use to provide inpatient care (the so-called "market basket"). In past years, the cost of blood had been inappropriately bundled in unrelated indices for "chemicals" or "miscellaneous goods." In response, in FY 2010 CMS agreed to use a new PPI that specifically tracks changes in the cost of blood products to hospitals. The Bureau of Labor Statistics now collects data from blood centers for this separate PPI for blood and organ banks. AABB and its fellow blood organizations will continue to work to ensure that the new index does, in fact, reflect changes in blood costs as accurately as possible.
In the realm of outpatient reimbursement, AABB was a staunch advocate for separate ambulatory payment classifications (APCs) for individual blood products and services when CMS first established the APC outpatient prospective payment system in 1998. AABB continues to support improvements in the APC system to ensure it accurately accounts for the costs of blood and reflects the increasingly complex array of blood products and services. Specifically, AABB has urged CMS to use outside cost data provided by hospitals and blood centers to establish its outpatient payment rates for blood products, rather than continuing to rely on faulty CMS data.
In response to AABB's requests, CMS issued revised guidance regarding billing for blood under the hospital outpatient prospective payment system, which took effect July 2005. This guidance can be found at http://new.cms.hhs.gov/transmittals/downloads/R496CP.PDF. AABB, along with others in the blood banking community, continue to urge CMS to further update and improve its guidance regarding blood-related reimbursement.
AABB also is a strong advocate for improved Medicare reimbursement for bone marrow, hematopoietic progenitor cells and apheresis-related procedures. AABB, along with other interested organizations, have urged CMS to adjust its payments to hospitals for laboratory processing services associated with bone marrow and peripheral blood progenitor cell transplants to reflect their actual costs.
Finally, AABB has championed new or improved Current Procedural Terminology (CPT) codes for transfusion medicine and cellular therapy-related procedures. For example, in response to requests from AABB, the American Medical Association in 2005 issued new CPT codes for a pretransfusion electronic crossmatch test (86923) and for volume reduction of blood products (86960).
If you have questions relating to billing and reimbursement for blood products and services, please contact firstname.lastname@example.org.