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Reimbursement 

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

2009

7/17/09
AABB issues summary of sections of the CY 2010 proposed rule for the Medicare Hospital Outpatient Prospective Payment System that pertain to payment rates for blood products and transfusion and cellular therapy services

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.

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