Sheilag1
New
is it possible to get a part B drug (normally done in OP) reimbursed if administered during an inpatient hospital stay?
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki is it possible to get a part B drug (normally done in OP) reimbursed if administered during an inpatient hospital stay?
- Thread starter Sheilag1
- Start date
mikhaila
Contributor
Hello,
Below is a link from Medicare's site regarding the info I found about the issue you brought up.
See link for further clarification.
I highlighted the info that seemed pertinent to your question.
First, is this really an inpatient stay?
• You’re an inpatient starting when you’re formally admitted to a hospital as an inpatient with a doctor’s order.
Second, do you mean the medication is a self-administered medication given in a hospital outpatient setting?
As you can see below, Medicare states that in most cases, Part B doesn't pay for self-administered drugs given in the hospital OP setting.
It also mentions that most hospital pharmacies do not participate in Part D and what a patient would need to do if the hospital does not participate in Part D.
Below is a link from Medicare's site regarding the info I found about the issue you brought up.
See link for further clarification.
I highlighted the info that seemed pertinent to your question.
First, is this really an inpatient stay?
• You’re an inpatient starting when you’re formally admitted to a hospital as an inpatient with a doctor’s order.
Second, do you mean the medication is a self-administered medication given in a hospital outpatient setting?
As you can see below, Medicare states that in most cases, Part B doesn't pay for self-administered drugs given in the hospital OP setting.
It also mentions that most hospital pharmacies do not participate in Part D and what a patient would need to do if the hospital does not participate in Part D.
Sheilag1
New
Mikhaila, thank you so much for taking the time to address my question! This is actually a provided-administered only, part B medication, never self-administered. If this patient was truly an inpatient, would it not be paid as inpatient is part A (and included in the payment under IPPS/DRG) or are there circumstances/exceptions when a part B drug could be paid separately?
mikhaila
Contributor
Hello,
Generally speaking you are correct that the medication if medically necessary would be covered under Part A during an inpatient stay, according to CMS. Link below proving your point.
There is a stipulation that does benefit the patient where Part B may end up paying for a medication given during an inpatient stay. See highlighted info below.
You didn't mention the classification of the medication the provider is administering.
There are some medications that are covered under both Part B and Part D but there are caveats and exceptions to that because by law.
I do not think this exception applies to you but in case there is a detail that was not mentioned I will include the two links below.
Some medications that can be covered under Part B and Part D:
Part D legally cannot pay for medications that Part A and Part B covers (Page 6):
Generally speaking you are correct that the medication if medically necessary would be covered under Part A during an inpatient stay, according to CMS. Link below proving your point.
There is a stipulation that does benefit the patient where Part B may end up paying for a medication given during an inpatient stay. See highlighted info below.
You didn't mention the classification of the medication the provider is administering.
There are some medications that are covered under both Part B and Part D but there are caveats and exceptions to that because by law.
I do not think this exception applies to you but in case there is a detail that was not mentioned I will include the two links below.
Some medications that can be covered under Part B and Part D:
Part D legally cannot pay for medications that Part A and Part B covers (Page 6):
