Reader Question: Know the 'Routine' for Drugs and Supplies

Question: What is the protocol for billing facility procedures (such as a laceration repair) and also billing for the supplies? Are the supplies included in the APC for the procedure? Does it make a difference if we're billing Medicare?

Florida Subscriber

Answer: The reimbursement you receive from Medicare includes expenses for supplies, part of the nursing care, and medications. However, you should still report drugs and supplies separately. Here's why: If you're billing Medicare, the government uses the data collected from your claims to determine the ambulatory payment classification (APC) rates. So if you fail to report them, eventually Medicare may reduce the APC reimbursement, because the government will think facilities aren't bearing that expense.

If you're billing a private payer, you should report drugs and supplies separately because some payers do reimburse for these items individually.

Whether you're billing Medicare or another insurer, make sure you establish a policy to charge all insurers the same amount for drugs and supplies. Routine supplies are included in the payment for a primary procedure or service, and therefore aren't separately billable. Examples of some common routine supplies include gloves, drapes, gowns, preparation kits, syringes, and reusable equipment, such as pulse oximeters and cardiac monitors.

But beware: No foolproof list of what is and isn't separately billable exists, so your facility should either develop its own criteria or check with your fiscal intermediary.

- Reader Questions reviewed by Sarah L. Goodman, MBA, CPC-H, CCP, president of SLG Inc. Consulting in Raleigh, N.C.