For the Week of January 26, 2015
I just read your November 17, 2014, Q&A related to Medicare OPPS reimbursement for blood-clotting factors. Can you provide information related to inpatient payment?
Blood-clotting factors administered to inpatients with hemophilia are eligible for separate Medicare payment under the inpatient PPS. Accordingly, if a beneficiary is in a covered Part A stay in a PPS hospital, Medicare reimburses the hospital for the blood-clotting factors in addition to the MS-DRG payment.
For more details about this coverage, go to Chapter 17, section 20, of the Medicare Claims Processing Manual http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c17.pdf.
To view and archive of the Pharmacy Compliance Question fo the Week, click here