Itemized Bill Review for Inpatient Routine Services
Governance of Humana's review and payment determination process for itemized inpatient facility bills to verify whether supplies, items and services are separately billable from the room and board (routine) charge; applies to Humana Medicare Advantage, Commercial and Medicaid products and providers billing inpatient claims.
No material clinical or coverage changes in this revision.
Items Not Separately Billable (Routine / Room & Board)
Items typically not separately billable
Humana typically considers the following items not separately billable (i.e., included in the general room and board or primary service charge):
ALL of the following
Examples
- Supplies, items and services that, under customary charging practices, are included in charges for a specific service or in charges for the delivery of services in a specific location (examples include bandages and inpatient assessments).
- All items and supplies that may be purchased over the counter, such as personal care items, ice packs, alcohol wipes and cotton balls.
- All reusable items, supplies and equipment that are provided to all patients on a routine basis during an inpatient admission (applies to all types of inpatient admissions, including specific treatment areas such as a NICU or CCU). Examples include cardiac monitors and durable medical equipment (DME) items used while inpatient.
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