Home Infusion Therapy Impact on Home Health Billing

Medical billing has seen multiple changes because of the COVID-19 pandemic. We’ve covered the Hospital at Home and its potential impact on hospital billing, but more changes are emerging. Take, for example, advances in home infusion therapy to meet the needs of social distancing and to give relief to healthcare providers whose on-site resources have been strained.

Home infusion therapy has evolved to meet this challenge, with new treatments emerging and the government responding with new home health billing guidelines. This means organizations like yours should catch up with these changes so that you’ll be prepared to adjust your medical billing and coding strategies to optimize reimbursement and stay compliant. Here are some of the changes we see as the most important today.

Health Systems are Investing in Home Infusion Therapy
First, it’s important to understand that many health systems are capitalizing on the home infusion therapy trend [1].

Home infusion therapy is a great way to support patient health while keeping them in their homes and simultaneously keeping costs contained. This is especially true for the U.S. ageing population, where providers see a rise of cases of chronic disease that require intravenous (IV) medications. For example, over the last decade, U.S. home infusion and specialty providers have seen a 300% increase in the number of patients cared for, bringing the total to 3 million in 2019.

But there are other benefits. Home infusion supports better outcomes with infusion providers having a positive record of providing high quality care and supporting IV therapy compliance with fewer complications. In the age of consumer-driven healthcare, it also supports communication outside the healthcare setting through secure messaging and other technological advancements.

Still, there are challenges. Asset management of infusion devices like enteral pumps and ventilators can be difficult even on-site and becomes more complex in the home infusion context. Health systems must address similar challenges in medication management, with some choosing to discharge patients with the products they need. Both asset and medication management pose complex billing questions as home infusion becomes more common, meaning some providers should consider working with experts to address any coding and home health billing questions that might arise as they try to take advantage of the home health infusion trend.

New Therapies are Being Used to Treat Multiple Diseases
We are now also seeing new models of care emerging for treatments of disease.

Multiple Sclerosis
The drug, natalizumab has been deemed as an effective treatment for multiple sclerosis through 4-weekly infusions, usually provided in a hospital outpatient setting. A study of a model of care addresses the provision of the treatment through home infusions. The benefit is that it prioritizes the nurse-patient therapeutic relationship and prioritizes patient needs [2].

Multiple sclerosis affects over 400,000 Americans in the commercially insured population alone, so advancements in its treatment can have an impact on billing practices [3].

At Home Cancer Care and the Pandemic
Similar shifts have been seen in at-home cancer care. Many hospitals dramatically reduced in-person visits during the pandemic, pushing toward options like telehealth and home care. According to Clinical Oncology News, many cancer centers also switched some patients to oral oncology medication instead of infused therapy along with expanding home infusion services. As the pandemic levels off, there will be a return to on-site treatment, but some centers expect that patients have come to prefer home care and will ask to continue it.

For example, Darcy Malard Johnson, PharmD, oncology pharmacy program manager at Minnesota’s M Health Fairview has seen these trends play out at her organization.
“We started to do some planning for the pandemic in February. We had a command center working on our strategies for the cancer clinics and the infusion centers. We looked at the treatments we provide to identify opportunities to provide care in a different way. In addition to switching to oral therapies, this includes subcutaneous injections patients could self-administer at home, switching to products with longer dosing intervals and ‘leveraging home infusion capabilities.” [4]

In these types of cases, these centers prepare to adapt their home health billing practices as they move forward.

Home Infusion Therapy is Changing Home Health Billing
The 21st Century Cures Act has made changes to how Medicare home infusion therapy is handled. These changes went into effect January 4, 2021, and an overview is available on the CMS website. The document addresses topics including:

  • Coverage of professional services
  • The definition of a home infusion drug
  • Reimbursement of different types of therapies
  • Coding for multiple drugs of different payment categories when administered on the same calendar day

In general, healthcare providers should pay close attention to home infusion therapy billing, since there are multiple nuances. For example, in 2021, home health agencies can apply for status as qualified home infusion therapy suppliers and directly bill professional services to Medicare. This adds a level of complexity, but also presents a potential new path of revenue generation. They will need to stay aware of specific billing changes such as which types of HIT services qualify for reimbursement, as well as how nursing services are reimbursed, since only nurses that are physically on-site the day an applicable drug is administered can be billed for reimbursement (in contrast to remote care).

If you are concerned about the impact and potential opportunity of home infusion therapy for home health billing and coding at your organization, we’d be happy to lend our expertise. Just contact us to set up a time to talk.

[1]Drafted in partnership with McKesson, “Why many health systems are capitalizing on the growing home infusion therapy trend,” Becker’s Healthcare, 23 October 2020. [Online]. Available: https://www.beckershospitalreview.com/pharmacy/why-many-health-systems-are-capitalizing-on-the-growing-home-infusion-therapy-trend.html.
[2]T. J. Schultz, A. Thomas, P. Georgiou, L. Cusack, M. Juaton, L. Simon, K. Naidoo, K. Webb, J. Karnon and J. Ravindran, “Developing a Model of Care for Home Infusions of Natalizumab for People With Multiple Sclerosis,” Journal of Infusion Nursing, vol. 42, no. 6, pp. 289-296, December 2019.
[3]P. Dilokthornsakul, R. J. Valuck, K. V. Nair, J. R. Corboy, R. R. Allen and J. D. Campbell, “Multiple sclerosis prevalence in the United States commercially insured population,” Neurology, vol. 86, no. 11, pp. 1014-1021, March 2016.
[4]Clinical Oncology News, “At-Home Cancer Care, Infusions Widespread Amid Pandemic,” 14 December 2020. [Online]. Available: https://www.clinicaloncology.com/Community-Oncology/Article/12-20/At-Home-Cancer-Care-Infusions-Widespread-Amid-Pandemic-/61420.

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