Separate billing codes burdensome, says NHIA

ALEXANDRIA, Va. - The National Home Infusion Association (NHIA) in May filed a complaint against CMS for violating its own rules.

Under HIPAA, CMS requires that all health plans use standard medical codes. However, Medicare billing codes for home infusion differ from industry-standard HCPCS codes.

"All providers, suppliers and clearinghouses are required by law to use those standard codes," said Bruce Rodman, vice president of health information and policy for NHIA. "Even if they don't pay on a given code, they are still required to accept it and process it. They cannot reject it as an invalid code."

Medicare Part B doesn't even cover home infusion therapy, but if a patient has both Medicare and secondary insurance coverage, home infusion providers must first bill Medicare--using the Medicare codes--and get a denial before they can submit claims to the secondary payer using the industry-standard codes.

"It's absolutely insane," said Bob Simmons, vice president and co-owner of Boston Home Infusion in Dedham, Mass. "You bill then get a denial and then turn around and bill with different codes. And, if Medicare sends the wrong denial code, that's another animal. You wind up chasing them to try to get the right denial code."

All in all, the requirements are burdensome for home infusion providers, and it's time for CMS to improve them, says the NHIA.

CMS has an office that is responsible for enforcing the HIPAA coding standards, and NHIA is waiting to hear a response on its complaint, said Rodman.

"We believe it's a clear violation of HIPAA policy," he said.