Humana denials on chemo waste based on vial size

Humana is denying payment on our chemo waste based on what size vial we should have used; not what is documented as waste.

Example: We billed for 34 units and 26 units were documented as waste from a 60 mg vial.

Humana is denying to pay for 26 units of waste. Humana states that we should NOT have used a 60 mg vial. According to Humana we should have used a 30 mg vial and a 10 mg vial for the 34 units to be given and we should have billed for only 6 units of waste.

We have filed several appeals and have not received a response.

Is anyone else seeing this trend? Any ideas on how to fight this denial?

Comments

  • We have received similar denials. Unless there is no smaller vial size manufactured or you can prove that the smaller size was not available or back-ordered, I don't think it can be a successful appeal. Payers want us to use the smallest vials possible to get the dose we need. If someone can offer a successful appeal strategy, I'm all ears.

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