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MandyBrooks1980

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We do infusion therapy for some of our patients, but instead of doing them in house they take their medications home with them so that it is cheaper. They are able to do their own infusions without the aid of a medical staff or facility. We are on the fence about how this should be billed out. Should there be a progress note made that the doctor signs off on every time the patient gets their infusion, or is it ok just to create a super bill and bill off of that since the patient isn't seen by a doctor? We are charging them for the medication that they get from us as a Buy and Bill.
 
You cannot bill for services that were not performed by your providers or their staff. If the patients are administering their own medication, you cannot bill for an infusion, only for the drugs and supplies that you have provided to the patients. To bill for an infusion, it would have to have been performed by staff and appropriately supervised by the provider.
 
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Thank you

We are only billing for the drug and supplies, but we mail it to them. The problem is how do we document this? Does there need to be any documentation for home services that a doctor doesn't over see? Does the doctor need to sign off on anything or can this just be done as a super bill and billed?
 
If this is the case, it sounds to me as though you are functioning in this respect more as a mail-order pharmacy and DMEPOS supplier, not as a physician office - in my 20 years in this field I've never heard of a physician office mailing prescription medications to patients, so this appears highly unusual to me. Physician documentation and coding guidelines would not really apply to this situation as you are not providing face-to-face or professional services for patients. I'd recommend you look into the CMS and state regulations as to the requirements for these kinds of entities as it's very different from just operating a medical practice. It would probably be a good idea to have your practice's legal advisors give you some input as there are likely other things to consider beyond just documentation, such as credentialing/licensing and quality controls. I'm not sure you'll find the expert guidance you need on this forum here as the AAPC scope is mainly focused on coding of professional services.
 
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