Anyone have any financial info you could give me about reimbursement for MD based infusion center. just a ballpark for a couple of average outpt visits. I'm looking for specific $$ amounts (ballpark will do).
I have cpt codes for the actual procedure but i think there are additional ones for viist/supplies, etc. i know this is really vague, but we're looking for some idea of what a typical mcr patient visit would bring in (understanding there would be different reimbursement depending on insurance providers)
Example:
Patient comes in for picc dressing chg and labs weekly
Patient comes in for daily infusion (procedure only, not drug)
Patient comes in for port access and labs
thanking you in advance for any info anyone can provide.
deb riley rn crni, infusion supervisor
summa's homecare
akron ohio
www.cms.gov is the website to get Medicare figures
go to physician payment - go to physician payment calculator and type in your code numbers
Kathy Kokotis RN BS MBA
Bard Access Systems
We are a hospital baised outpatient infusion center, but I believe some of the rules are the same.
We charge a visit level only if we do something that is not part of the expected visit - ie need to assess w new or worsening symptom, needing to call the doc in to evaluate something, or treating a reaction to a drug we gave. According to the current standards, visit levels can be defined by each center. Apparently the guidelines are going to be much more specific in a few years.
Charging for supplies - In the CPT book it lists some supplies and tasks that cannot be charged for - usual IV tubing, starting the IV, and a bunch of stuff. That has been preety standard for the last few years, but can change yearly. In general, supplies that are charged on an inpatient basis can be charged outpatient, and there may be some expensive items that you can charge for in your center that they don't charge for inpatient.
I recommend that you find the Coder that works in the area (outpatient and physician office)and become their best friend. We have a couple of excellent ones that have guided me through most of the decision making. Also whoever does the charging for procedures and supplies at the local ER probably is following the same rules that you will need to. There are things that cannot be charged the same visit, modifers to use, heirachy rules when charging IVs (and that is apt to change yearly).
I do know what we charge for each procedure and supply, but I am not the one who is following the actual reimbursement. I am in a Critical Access hospital, so my reimbursement percentages will be better than most. I do know that we give the Neulasta for 2 other local hospitals - their reimbursement doesn't cover the cost for the med.
If you would like more specific information let me know - we can do it off list if you want.
Gail McCarter RN CRNI
Gail McCarter, BSN,CRNI
Franklin, NH