Explore our free mid-revenue cycle articles and webinars here.

Ask a Rev Cycle Expert: Medicare billing rules for SNS?

Question:

If a Medicare-enrolled provider or supplier receives drugs or supplies (including testing supplies) from the Strategic National Stockpile (SNS) or other drugs or supplies procured or provided by a governmental entity, what are the Medicare billing rules? How should these providers and suppliers handle billing for services and supplies that involve the use of SNS or other federally provided drugs or supplies?

Answer:

A provider or supplier’s use of drugs or supplies procured or provided by a governmental entity to diagnose or treat patients with known or suspected COVID-19 would not affect Medicare’s payment for the service under the applicable prospective payment system or fee schedule. Although Medicare usually doesn’t allow payment for services that are paid for by a governmental entity, there is an exception for services furnished as a means of controlling infectious diseases (see 42 CFR § 411.8(b)(4)). However, providers and suppliers should not seek additional payment on the claim for these drugs or supplies, as described in the CMS Internet Only Manual, Pub. 100-04, Chapter 32, Section 67. In addition, providers and suppliers that submit Medicare cost reports should not reflect the costs of free drugs or supplies on their cost reports. In contrast, providers and suppliers should follow ordinary billing rules for drugs or supplies purchased from governmental entities….”

https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf

Disclaimer: This information was current at the time of its publishing and is designed to provide accurate information in regard to the subject matter covered. Vitalware does not accept any responsibility or liability with regard to any errors, omissions, misuses, or misinterpretation by the reader. It is not intended to take the place of either the written policies or regulations. We encourage you to review the specific regulations and other interpretive materials as necessary. All CPT® codes are trademarked by the American Medical Association (AMA) and all revenue codes are copyrighted by the American Hospital Association (AHA).