What are the home infusion therapy fee schedule and contracting issues brought upon by standardization of coding under HIPAA?
Providers and payers should be aware that converting codes may mean restructuring of your contracts is necessary. Payers must convert their claims processing systems from custom codes to HIPAA-approved codes. For most commercial payers and even some Medicaid programs, the new codes will be the per diem “S” codes. This means some payers will be approaching providers with proposals for restructured contracts to match these codes. Such payer actions will escalate rapidly as most have only until October 16, 2003 to complete their conversion to the standardized per diem codes per HIPAA regulation. Each home infusion per diem HCPCS code specifically includes “administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment.” This is an important recognition in CMS’ coding system that these services are a critical component of infusion therapy. Payers should benefit from providers’ discussion and education on infusion services and costs, why
