HH & Lab billing

Specialties Home Health

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I am a new director of a small home health agency. This agency recently obtained a Prothrombin machine and the nurses have been using it for monitoring PT's per MD orders for our coumadin patients. I think this test falls under our CLIA Certificate of Waiver and that we can bill Medicare for the test instead of absorbing it into the PPS payment as they have been to this point.

Anybody have the info?

Thanks in advance for help you can offer.

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What a wonderful addition to your office. I would love to have one of these in ours! Saves a lot of time dropping off at hospital plus you can get the results faster. I don't know the specifics of what you are asking, but it seems logical that it should be billed seperately. If you took the blood to the lab, they would bill and doing bloodwork in the office is not considered part of our services. How it needs to be done, I'm clueless. How about talking to a MD office that does labs inhouse?

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Specializes in Vents, Telemetry, Home Care, Home infusion.

medicare reimbursement policy covers only patients with heart valves on warfarin for minimum of 3 months prior to homecare testing.

coverage and billing for home prothrombin time international normalizedratio (inr) monitoring for anticoagulation management (see page 30)

reference: transmittal ab-02-180, change request 2323

mnb-nj-2002-2, june 2002

the centers for medicare & medicaid services (cms) has issued program memorandum ab-02-180 in which it deleted the segment "this is a clia waived test." all other information regarding coverage and billing for home prothrombin time inr monitoring for anticoagulation management remains the

medicare website:

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Specializes in MS Home Health.

The test does need to be included on your waiver paperwork plus you need a competency program to teach its use, a program on how to care for the machine, who is going to calibrate it/quality control check, who is allowed to operate it, and all the records that go along with all the above.

Coming from the educator side, personally I would not want to create the program to do that or keep all the records related to this. Just be prepared you may get someone to show up and check all those records and add that program education to your competency program at the hire date skills checking as well as your defined timeframe for re-compentency.

renerian

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I am a new director of a small home health agency. This agency recently obtained a Prothrombin machine and the nurses have been using it for monitoring PT's per MD orders for our coumadin patients. I think this test falls under our CLIA Certificate of Waiver and that we can bill Medicare for the test instead of absorbing it into the PPS payment as they have been to this point.

Anybody have the info?

Thanks in advance for help you can offer.

The agency I worked for also used the Protime machine,the training was treated the same as for our glucometers. Once a year competency checks,the machine does its own self check each time its used,if there are any problems a code number pops up which you document on the supplied log and the supply room clerks would followup with our nurse educator. I know we billed separately for it and were reimbursed but I don't know the specifics.It is very accurate and convenient to use.and if there was any problems you would have vp supplies as a backup.MD's like being able to adjust coumadin immediately,the machines are not cheap(about 5,000 dollars each) so I know we were getting reimbursed for each use as the facility I worked for would not have absorbed the cost and we had six machines and supplies.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

found this tonight while reading cahaba's hh reference guide:

240.35 [color=#231f20]protime test systems (pg. 81)

[color=#231f20]

according to cms, protime test systems are neither durable medical equipment nor medical supplies. [color=#231f20]these systems, used by physicians and health professionals only, are unsatisfactory for use in beneficiaries' homes. medicare makes no payment for provider, physician, or supplier distribution. the dupont coumatrak is an example of this item.

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i do know of some agencies just eating the cost due to increased physician satisfaction and decreased nursing down time. check with your managed care payors to see if they will cover the cost.

my large hh agency does not allow nurses to carry glucometers, pulse ox nor coumatrack due to clia requirements, compentency testing, need for calibration documentation and liability issues.

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I know this post is several years old, but I may have some info that can help you. You can bill for the PT/Inrs separately through your CLIA waiver. However, the reimbursement you will qualify for is an administrative reimbursement-not the technical fee. This reimbursement is for documenting the results of the lab as well as communicating the results to the physician. You can receive this reimbursement for all of your CLIA waived labs. I won't go into much more, as I am new to this site and don't even know if you will be notified that I posted this response. If you are, send me a message and I will fill you in.

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Can you please help me with this lab related question. I have a private insurance pt who had recieved an order for labwork from another doctor/specialist, and the pt went ahead and got it done from a lab. Now, can u tell me if the insurance is going to deny payment to the lab and what is the best way to handle a situation when such an order is given by a physician who hasn't signed the POC. Thank you very much in advance.

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Hello,

i myself work with a home health care business, I am having this same problem going on here, I was wondering have you found out what it takes to do this billing for clia waived labs?

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