Beyond the front-end tasks are these items to be managed:
- payer-specific rules for Medicare, Medicaid, and commercial payers (some noted below)
- administration fees for infusions
- codes for chemotherapy
- therapeutic infusions for an hour and then for extended times
- sequential and concurrent infusions
- IV push infusions for single and then for additional sequential infusions
- therapeutic SubQ or IM infusions
- hydration infusions for the initial 31-60 minutes and then for each additional hour
Then there are the J-Codes, which need to correspond to National Drug Code (NDC) formats for infused drugs such as:
- J1745 – Remicade (Infliximab)
- J9312 – Rituximab
- J9355 – Trastuzumab (Herceptin)
- J1439 – Injection, Ferric Carboxymaltose (Injectafer)
- J0885 – Injection, Epoetin Alfa (Epogen, Procrit)
- J0129 – Abatacept (Orencia), per 10 mg
- J1569 – IVIG infusion, per 500 mg
And then there are the payer requirements as mentioned above, a partial list being:
Medicare and their prior authorizations, incidence-to-billing rules, bundling (NCCI editing), start and stop times.
Medicaid and how coverage varies by state, stricter medical documentation, and nuances based on the infusion’s place of service.
Commercial Payers and how they’re so payer-specific on infusions, drug wastage, how home infusions vary by payer, and more.
Let’s not forget the modifiers, three of which include:
- JW – Drug wastage (report discarded medication)
- 25 – Separately identifiable E/M service on the same day
- 59 – Distinct procedural service (for multiple infusions)
There’s more on infusion documentation and compliance:
- Start & Stop Times: Mandatory for Medicare and recommended for all payers.
- Physician Orders: Must be signed and specify infusion details.
- ICD-10 Diagnosis Codes: to ensure alignment with drug necessity.
- Consent for Treatment: Required for certain high-risk medications.
- Medical Necessity Justification: Essential for high-cost drugs.
On the clinical charting and reporting side, you’ll want to use an ONC-certified EHR designed for infusion therapy, which can automatically configure claims to conform to the abovementioned requirements.
You can do your best to stay on top of everything needed or breathe a sigh of relief with ADSRCM as your collaborated AI-driven service. Besides the items already mentioned, you’ll have eligibility verifications, out-of-network alerts and proactive denial alerts and management, claim tracking, EOB reconciliations, and mileage billing for infusions outside your center.
We generate your patient statements either by email or paper; our balance due texting option is available as well. Payments can be made online directly to you, and patients are directed to call us if they have statement questions
You’ll have transparent, on-demand access to all of your data. You’ll be able to compile any financial and operational reports, analytics, KPIs, and dashboards in addition to the analytics reviews routinely provided by the ADSRCM team.
You’ll also have access to the ONC-certified MedicsCloud EHR, which is ideal for infusion therapy, or you can keep your existing EHR interfaced with us.
Contact us for more about how we can help you streamline your infusion center and about our 90-day guarantee to increase your revenue!
