|In visits to hospitals around the United States, Craneware has observed much uncertainty about how self-administered drugs should be handled in Medicare claims. Generally, self-administered drugs are not covered by the Social Security Act, but there are some notable exceptions. Hospitals should familiarize themselves with those exceptions, so that they do not pass up reimbursement to which they are legitimately entitled.
- Understand how SADs are defined by Medicare and Medicaid.
- Identify the coverage requirements for drugs and biologicals.
- Identify exceptions that permit SAD reimbursement.
- Understand Medicare and Medicaid policies regarding non-reimbursable SADs.
|William L. Malm, N.D., R.N., Healthcare Consultant, Craneware|
William L. Malm is a nationally known author and speaker on topics such as compliance, chargemasters, and RACs. Malm has more than 25 years of experience in a com¬bination of clinical and financial healthcare. He specializes in operations surround¬ing chargemasters and compliance including CDM maintenance, implementation and charge capture processes surrounding the CDM, and compliance reviews. Having served in audit and compliance throughout his career, Malm has extensive experi¬ence with all post-payment audits, including the recovery audit contractors (RAC). Additionally, he has served as a systems compliance officer at a large for-profit healthcare system and has conducted hundreds of pre-pay and post-pay audits.