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
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:
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.
Claim edits do not supersede the necessity to obtain preauthorization. Preauthorization requirements are still applicable. Modifiers should be used when appropriate to accurately represent the services rendered. The use of modifiers may impact Humana’s application of these edits. For additional information, consult professional coding resources.
*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.