Use Pass-through List Effectively to Get Paid for Drugs, Devices and Biologicals

In March 2000 the Outpatient Prospective Payment System (OPPS) listed 149 potentially eligible pass-through items. Since then HCFA has approved nearly 1,000 items for pass-through payments. Keeping up with the list updates, which are issued periodically, is a challenge you must be prepared to handle. Otherwise your facility could lose money for items you did not know you could bill for.

Facilities must have a point person who either updates the list or makes sure it gets done. A person already on staff can be put in charge, but some experts recommend you add a full-time staff member, depending on the size of your facility. Communication with this person will be important when checking inventory or ordering supplies.

Develop and Implement Your Pass-through List

Here are several elements you need to know to use the pass-through list effectively.

1. Get comfortable and knowledgeable searching for updates and using HFCAs Web site. The original 149-item list is in the interim final rule in the Federal Register. The updates occur periodically, so check regularly to see if any have been added. You can access several program memorandums about the pass-through list on the HCFA Web site (www.hcfa.gov). The memos you need to refer to: A-01-10, A-00-96, A-00-82, A-00-72, A-00-61, A-00-42, A-00-48, A-00-36, and AB-00-86. Since the updates havent occurred regularly, you will need to check periodically to see if any have been added. Memo A-00-82, which was published on Nov. 3, 2000, lists the new items that became effective for pass-through payments for Jan. 1, 2001. The newest memo, A-01-10, lists new long descriptors for 28 C codes. It also states that code C8100 (adhesion barrier) is no longer covered.

To view the various memos log onto www.hcfa.gov/pubforms/transmit/a0073.pdf. To view other memos, change the address by inserting a0082 or any of the other memo tags into the address for a0073.

Keeping up with the list can be time consuming and confusing, but staying informed about changes is the only way to ensure proper use and reimbursement. I dont think people realize how many updates there have been, explains Carle Nicklas, implementation manager at First Consulting Group, a healthcare information systems consulting firm headquartered in Long Beach, Calif. Unless you have someone tracking it full time, its very easy to miss an update.

2. Keep an eye on which items you are using. When you order new inventory, check if the items you are purchasing are eligible for reimbursement. You dont want to order a product, use it, and later discover that there is a comparable item on the list. You wont be able to bill for items not on the list by using comparable codes.

3. Know the codes to [...]

- Published on 2001-02-01