Mrsrpc
Guru
Trying to verify what I’ve been told to do bc the instructions were vague: 1. the HOPD bills Medicare via claim for the facility fee and / or pro fee, depending on whether method I or II is used or if pass-through is used. Payment made for procedure based on 101% of reasonable cost ( as opposed to OPPS payment amount)
2. Then a separate payment is made in a lump some for supplies bc they are also paid at 101% of reasonable cost? (HCPCS A4649)
Is this right? How are reasonable costs determined for the facility and pro fee if those do not include supplies? I am aware bundling such as is done by the regular ( non CAH) HOPDs does not apply to CAHs. Any CAH billers out there who can clarify for me? TIA
2. Then a separate payment is made in a lump some for supplies bc they are also paid at 101% of reasonable cost? (HCPCS A4649)
Is this right? How are reasonable costs determined for the facility and pro fee if those do not include supplies? I am aware bundling such as is done by the regular ( non CAH) HOPDs does not apply to CAHs. Any CAH billers out there who can clarify for me? TIA