Hemophilia eCBR

This electronic Comparative Billing Report (eCBR) focuses on providers that submit claims for patients receiving care in Hemophilia with Clotting Factors. 

eCBR information is one of the many tools used by Palmetto GBA to assist individual providers in identifying variation and improving performance. Becoming proactive in addressing potential billing issues and performing internal audits will help ensure you are in compliance with Medicare guidelines.

For your personalized Hemophilia Clotting Factors results, please logon to eServices. 

Overview of Hemophilia with Clotting Factors
According to the Centers for Disease Control and Prevention (CDC), Hemophilia is usually an inherited bleeding disorder in which the blood does not clot properly. This can lead to spontaneous bleeding as well as bleeding following injuries or surgery. Blood contains many proteins called clotting factors that can help to stop bleeding. People with hemophilia have low levels of either factor VIII (8) or factor IX (9). The severity of hemophilia that a person has is determined by the amount of factor in the blood. The lower the amount of the factor, the more likely it is that bleeding will occur which can lead to serious health problems.

The standard way to treat both hemophilia A and B is to replace the missing blood clotting factor so that the blood can clot properly. One way to do this is by infusing (injecting into a vein) commercially prepared clotting factor concentrates. This can be done by the patient themselves, in their home or in a Hemophilia treatment center.

Documentation must comply with all legal and regulatory requirements applicable to Medicare claims. CMS outlines its minimal documentation requirement in the Medicare Benefit Policy Manual Publication, 100-02, Chapter 15, Section 50, Drugs and Biologicals (PDF).

CMS works to eliminate improper payments in the Medicare Program and protect the Medicare Trust Fund, as well as beneficiaries from medically unnecessary services or supplies and their associated costs. CMS calculates a national Medicare Fee-For-Service (FFS) improper payment rate and improper payment rates by claim type and publishes the review results annually.

Methods
The metrics reviewed in this eCBR are the proportion of billing for claims rejected for improper use of Modifiers JZ, JW, JG, TB, PO and PN vs. all Hemophilia with Clotting Factors billed claims for comparisons done to peers within the state and jurisdiction. This report is an analysis of Medicare Part A claims extracted from the Palmetto GBA data warehouse. The analysis shows the portions of your billing at each level compared to your peers in Jurisdictions J and M.

Example of eCBR

Resources

• CDC About Hemophilia
   
• Medicare-FFS Program Billing 340B Modifiers under the Hospital Outpatient Prospective Payment System (OPPS) Frequently Asked Questions (PDF)
   
• CMS IOM, Medicare Benefit Policy Manual, Publication, 100-02, Chapter 15 (PDF)   
   
• MLN Matters® Article: MM 13056 — New JZ Claims Modifier for Certain Medicare Part B Drugs (Related CR Title: New Claims Modifier Requirement for Drugs and Biological from a Single Dose Container or Single-Use Package) (PDF)
   
• MLN Matters® Article: MM9603 — Revised JW Modifier: Drug Amount Discarded/Not Administered to any Patient (PDF)
   
• Medicare-FFS program Billing 340B Modifiers JG or TB (PDF)
   
• HCPCS Modifier JZ