Home Infusion
What is home infusion?
The administration of medication through a needle or catheter…typically administered intravenously but can be administered by intramuscular injection and epidural routes.
Healthcare Common Procedure Coding System. Codes used to represent medical procedures to Medicare, Medicaid, and several other third-party payers.
HCPCS
What is a fixed amount that an insured person must pay as out of pocket before the insurer will reimburse benefits; usually annual; not to be confused with co-insurance.
Deductible
What term refers to the knowledge of drugs?
Pharmacology
What is a place of service?
Where the health service is being performed, i.e. home, hospital, office, clinic, etc.
When an adjustment is required, when is it necessary to submit the adjustment for approval?
Anything over 1K per account per day
Application used by patient registration to complete the intake process
Reference Point
What therapy is nutrition administered intravenously to bypass the gastrointestinal tract.
Total Parenteral Nutrition (TPN)
What is the purpose or goal of home infusion?
To provide excellent care to a patient in their home setting, cut costs of inpatient services, eliminate patient contact with illnesses.
A code that includes all home infusion services, equipment and supplies, except the prescribed drug(s) and licensed nursing services for each day the drug is administered
Per Diem
Home infusion supplies and services can be billed to various parts of insurance programs called benefit types, which include.. (list at least 2)
Medical benefit, pharmacy benefit, durable medical equipment benefit, home health nursing benefit
Term used to describe a prescription label
sig
Rosie is billing for a patient that is on multiple therapies. The commercial payer she works with requires a modifier be added to each claim after the first one. What modifier would he most likely add to the second claims lines?
SH
The difference between what a healthcare provider bills for the service rendered versus what it will contractually be paid
Contractual Adjustment
What does the acronym HIPAA stand for?
Health Insurance Portability and Accountability Act
Which therapy includes a drug used to treat Amyotrophic lateral sclerosis (Lou Gehrig's disease).
ALS
Aside from the patient's home, what other option does OCH offer patients to receive infusions?
Ambulatory Infusion Suites (AIS)
Drugs are identified and reported using a unique, three-segment number called this.
NDC
Federal health insurance for people 65 or older, some younger people with disabilities, people with End-Stage Renal Disease.
Medicare
Used to specify "as needed"
PRN
What is a code that provides how the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but has not changed in its definition or code.
Modifier
Assume you are a collector and need a diagnosis code updated in the system and the CMC needs to update the patients orders to include it. Which process would you follow to get the diagnosis code updated?
CMC Denial Review Process
What does the acronym AVA stand for?
Area Verification Authorization
What therapy or drug is used to lower the risk of preterm delivery. Usually given in the doctor’s office.
Makena (MAK)
What are the two categories of home infusion therapies offered at OCH?
Reusable medical equipment that can withstand repeated use
Durable Medical Equipment (DME)
A requirement by a payor that a provider must justify the need for services before providing them to the patient.
Prior Authorization
A physician orders drug “x” 500 mg BID X 30D. The pharmacy has drug “x” 250 mg in stock. How many 250 mg tablets of drug “x” are needed to fill this order?
120 tablets
HCPCS codes that should only be used when a more specific HCPCS or CPT code is not available.
NOC
A code within the AR manager used to indicate where the claim is at in the collections process.
SRC Code
The time it takes OCH to respond back to our customers with a patient’s coverage & financial responsibilities.
Time to Yes
Drugs used to maintain IV access while not being used for regular infusions.
Catheter Maintenance Therapy (CAT), flushes such as heparin/saline
What are the different administration methods available for home infusion patients? (Name at least 2)
IV Push, Intravenous, Bolus/Syringe, Gravity, Elastomeric, Intramuscular Stationary Pump, Syringe Pump ..
The process of paying or denying a claim after it has been submitted to the insurance company
Adjudication
This method of billing is called National Council for Prescription Drug Programs.
Pharmacy Benefit
How many tablets should be dispensed, given the following order?
Amoxicillin 250 mg tabs; sig 1 tab BID X 10 days
20 tablets
The portion of a medication bottle, syringe, or vial that is not given to a patient
Wastage
A calculation that compares Total A/R Aged over 90 days to Total Accounts Receivable
What is "Aging Over 90 Days"?
There are 10 intake goals, name two of the goals.
Accept Goal, Enrolled Goal, Benefits Goal, Orders Goal, Authorize Goal ,Patient Goal, Nursing Goal, Delivery Goal, Communications
Therapy when solution is injected into the bloodstream to remove heavy metals and/or minerals from the body.
Chelation Therapy (CHE)