Actions Needed to Stop Excess Medicare Payments for Blood and Blood Products: Report to the Congress

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General Accounting Office, 1979 - Blood banks - 49 pages
 

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Page 40 - I/According to Medicare instructions, blood costs generally consist of amounts spent by providers to procure blood, including (1) the cost of soliciting and paying donors and drawing blood for its own blood bank or (2) where the provider purchases blood from an outside blood source, the amount of credit which the outside blood source customarily gives the provider if the blood is replaced.
Page 7 - Medicare program expects that a provider of services will always act in a prudent and cost-conscious manner in seeking to minimize costs (section 2103 of HIM-15). To refuse to accept replacement blood raises not only the overall cost of blood (because replacement blood must be obtained elsewhere) but also disproportionately increases Medicare's share of the cost of blood where a provider accents blood replacement from non-Medicare beneficiaries but not from Medicare beneficiaries.
Page 32 - HEW direct the Administrator, HCFA, to: — Revise Medicare billing instructions to more clearly require that hospitals and blood banks allow Medicare patients the same opportunities as allowed nonMedicare patients to eliminate blood nonreplacement, replaceable blood processing, and component fees.
Page 42 - ... had a blood replacement policy which provided that all fees, including blood processing fees, were to be canceled if non-Medicare patients replace two units of blood for each unit used. Conversely, the blood bank did not allow the use of any blood replacement credits to reduce processina fees assessed to Medicare beneficiaries. This practice resulted in the Medicare program paying for all processing costs attributable to blood used by Medicare patients, and, in addition, processing costs attributable...
Page 7 - ... costs. Community and hospital blood bank replacement practices have not complied with Medicare regulations and related provisions of the Social Security Act. The blood banks we visited did not treat Medicare patients the same as nonMedicare patients for reducing or eliminating blood fees. The blood banks limited the number of blood credits they would release to offset nonreplacement fees for Medicare patients but placed no such limitations on non-Medicare patients. Some blood banks also allowed...
Page 11 - Officials at most blood banks reviewed told us their replacement policies were based on their understanding of Medicare requirements. For example, they said that Medicare pays for all nonreplacement fees after the first three units. However, only one blood bank director referred us to a written document supporting this position—a 1971 Medicare handbook designed to inform Medicare beneficiaries of their Medicare coverage. This document stated that: "Hospital insurance cannot pay for the first 3...
Page 14 - Percent of fees replaced . . 36.6 29.4 33.4 40.6 36. 1 .. the nondeductible units used. Based on discussions with HEW, we recognize that certain limitations in the data exist and that actual blood replacement could be somewhat higher. However, we believe that any necessary adjustments would not demonstrate significantly different results. Replacement credits would still represent only a small percent of the nondeductible units used. The lack of information on the additional unused blood coverage...
Page 23 - Administration, to: — Revise Medicare billing instructions to more clearly require that hospitals and blood banks allow Medicare patients the same opportunities as allowed nonMedicare patients to eliminate blood fees. — Revise Medicare instructions to provide that nonreplacement fees charged on processingfee-only blood are not allowable charges to Medicare. — Improve corrected billing requirements for late blood credits to more accurately and economically account for Medicare blood replacements....

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