BCBSM home infusion therapy benefits for Medicare patients clarified

In response to providers’ inquiries, we’re clarifying our home infusion therapy policy for patients who have the BCBSM commercial HIT benefit, with Medicare as their primary payer.

Determining which payer should be billed for home infusion therapy nursing services depends on who pays for the drug. Just because a patient is homebound, it doesn’t mean Medicare is responsible for the nursing services associated with home infusion therapies.

For patients with the BCBSM HIT benefit who are receiving home infusion, the benefits include the cost of the following:

• Drugs
• Supplies used to administer drugs
• Administrative services
• Care coordination
• Diluents and solutions
• Flushes
• Nursing services
• Professional pharmacy services

For homebound patients who have Medicare and the BCBSM HIT benefit, keep the following in mind:

• Medicare is primary only if it is paying for the patient’s home infusion therapy. This is extremely limited and must be approved by Medicare.
• BCBSM becomes primary when the home infusion therapy ordered is not covered by Medicare.
• When BCBSM pays for the home infusion therapy, all of the BCBSM HIT benefit requirements need to be met by the infusion provider.
• The HIT benefits include required nursing services. This is covered in the BCBSM HIT manual and contract.

BCBSM pays for home infusion therapy when:

• The home care agency can bill Medicare for nursing visits unrelated to home infusion therapy.
• The infusion provider cannot bill Medicare for nursing services. The infusion provider can bill BCBSM for home infusion therapy and the related nursing services, as stated in the BCBSM home infusion therapy benefit requirements.
• If the infusion provider subcontracts with the infusion nurse from the home care agency that is providing the Medicare skilled nursing services, the following applies:
  • The home care agency is a subcontractor and considered an employee of the HIT provider.
  • During infusion nursing visits, the nurse is considered an employee of the infusion provider.
  • The home care nursing agency may not bill BCBSM or Medicare for an infusion-related nursing visit.
  • The HIT provider bills all infusion-related nursing visits to BCBSM.
  • The infusion nursing visit is considered a separate visit and requires a separate nursing note with the focus on the infusion-related care.

The nursing note must reflect the BCBSM Home Infusion Therapy Provider manual description of nursing visits. For more information, see the “Conditions and Limitations, Nursing Visits” section of the manual.