Medicare Compliance & Reimbursement

Remember: As program evolves, so do claim categories

Keep claims clean--and reduce your exposure to possible fraud accusations--by ensuring that you're crystal clear on just what's covered under Medicare Part B and Part D.

Background: The Part D benefit covers some classes of drugs that are, in some circumstances, also covered under Medicare Part B.

Use this guide to keep claims on track and avoid any appearance of inappropriate billing.

• Durable medical equipment supply drugs: Part B for retail and home health care, Part D for long-term care
• Immunosuppressants: Part B for Medicare-covered transplants; Part D for other transplants.
• Oral anti-cancer drugs: Part B for cancer treatment under certain circumstances; Part D otherwise.
• Oral anti-emetic drugs: Part B within 49 hours of chemotherapy; Part D otherwise.
• EPO: Part B for treatment of anemia for beneficiaries who are undergoing dialysis; Part D otherwise.
• Vaccines: Part B for influenza, pneumococcal and, for patients at risk for Hepatitis B, Hepatitis B; other vaccines are covered by Part D.

New for next year: Effective Jan. 1, 2008, you can submit claims for Part D vaccine administration to Medicare Part D prescription drug plans (see Medicare Legislation & Regulation, Vol. 33, No. 33).

• Parenteral nutrition: Part B if prescribed for permanent dysfunction of digestive tract; otherwise, Part D. Source: Jeff Flick, the Centers for Medicare & Medicaid Services.