Bass, Berry & Sims attorney Shannon Wiley, with Carine Leslie and Katie Garmon of PYA, P.C., recently discussed the complexities associated with billing, coding, and collecting for infusion services as part of the Infusion Insights Webinar Series. As billing, coding, and collection errors can lead to insurer recoupments or potentially devastating False Claims Act, Anti-Kickback Statue (AKS), and Beneficiary Induction Civil Monetary Penalty Law (CMP) violations and associated penalties, infusion providers must ensure that their businesses comply with all applicable requirements.
The speakers discussed billing and coding practices for infusion centers adopting a Non-Physician Practitioner (NPP) business model. To facilitate a smooth billing process, NPP infusion centers must use the appropriate Current Procedural Technology (CPT) codes when billing for various infusion services and properly distinguish claims for primary and sequential items. Infusion providers must also identify certain highly complex drugs that may be subject to additional billing or supervision requirements imposed by commercial payors or Medicare Administrative Contractors (MACs) and ensure compliance with any payor or MAC-specific obligations.
Shannon explained Medicare Part B “incident to” billing requirements for physicians and nurse practitioners providing infusion services. These requirements impose specific supervision and treatment obligations necessary for providers to legally bill for drugs provided “incident to” a physician or nurse practitioner’s services. Such obligations, including “direct supervision” of nurses, vary based on whether infusion services occur at a hospital or other freestanding facility. Shannon highlighted flexibilities in direct supervision requirements afforded by COVID-19 Public Health Emergency (PHE) waivers and how freestanding infusion centers can appropriately implement remote supervision for the duration of the PHE.
Finally, the speakers laid out important compliance considerations that infusion providers should know when collecting payment for infusion services. If incorrectly implemented, copayment waivers can expose infusion centers to potential CMP and AKS liability. However, providers can maintain legal compliance through careful conformity with applicable exceptions and safe harbors. The panel also gave vital insights into best practices for patient discount programs, financial responsibility policies, copayment and deductible collections, and payment plans, with a special focus on the importance of clear documentation practices and procedures.
