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Code edit notification

Notification Number: 1367

Effective date: 7/7/2011

Notification date: 3/26/2011

Category: Correct Coding

Topic: Supplies and Equipment Included in Room and Board

Providers affected:

  • Inpatient/Outpatient Facilities
What is changing?

Equipment used multiple times for multiple patients or routine items will not be reimbursed.

According to CMS and Humana payment policies, routine items (e.g., gloves, bedpans, etc.) used for all patients, as well as equipment used for multiple patients, are not separately reimbursable. The following items are included in the reimbursement for room and board:

  • Personal comfort items that do not contribute meaningfully to the treatment of an illness or injury
  • Routine supply items found in the “floor stock” that would generally be available to all patients receiving supplies in that location

 

In order to be separately reimbursed, the item must have been delivered to or used on the patient for whom it was ordered.

Durable medical equipment (DME) must be billed directly by the supplier. Some DME items in the general categories of implanted DME, surgical dressings and prosthetics and prefabricated orthotics are billable.

It is not allowable to bill for either the cost of capital equipment or the rental of equipment owned by the inpatient facility.

This edit will only be applied after a detailed review of the claim. This notification applies to inpatient facilities.

For a list detailing Humana’s guidelines for routine supplies for inpatient facilities, please visit: Humana’s Guidelines for Routine Supplies.

 

Why is Humana implementing this change?
Humana periodically updates its policies and claims payment systems to be aligned with correct-coding initiatives as well as national benchmarks and industry standards.

Impacted products

  • Select self-funded* products
  • Commercial fully insured products
  • Medicare Advantage HMO products
  • Medicare Advantage PFFS products
  • Medicare Advantage PPO products

Disclaimer

*All edits previously posted on Humana.com/providers for fully insured commercial Humana members may be applied to self-funded members, when requested by the self-funded group.