Medicare Part B Services During Non-Part A Nursing Home Stays: Enteral Nutrient Pricing

摘要

To compare Medicares Part B fee schedule for enteral nutrients provided during non-Part A stays to prices available to nursing home suppliers and other purchasers. Medicare Part A covers nursing home care for up to 100 days in a skilled nursing facility during which Part A will pay for enteral nutrition therapy (ENT) as part of the nursing homes daily rate. After the 100 days or in cases when beneficiaries do not qualify for Part A stays, Medicare Part B may provide coverage for enteral nutrients, supplies, and equipment during these non-Part A stays. Enteral nutrients are delivered directly to an individuals digestive tract through a feeding tube inserted through the nose or placed in the small intestine or stomach. Nutrients are delivered through the tube using a syringe, gravity, or a pump. Medicare contractors use a fee schedule to reimburse for enteral nutrient claims. During 2006, Medicare Part B allowed $284 million for ENT provided to nursing home residents during non-Part A stays ($142 million for enteral nutrients and $142 million for enteral supplies and equipment). Two codes of the Healthcare Common Procedure Coding System, B4150 and B4154, accounted for nearly all ($117.8 million) of the $142 million allowed for enteral nutrients provided during non-Part A stays in 2006. As such, we focused our evaluation on these two codes. We used resident assessment data from the Centers for Medicare & Medicaid Services (CMS) to identify all nursing home stays nationwide during 2006. We then analyzed related Medicare claims data for any allowed ENT payments during these stays as well as information provided by a sample of nursing homes and suppliers relating to their costs. Additionally, we supplemented these results with industry pricing data gathered and maintained by a marketing research firm that reports capturing 84 percent of national market activity for enteral nutrients, including 94 percent of the volume sold to nursing homes in 2006.