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Medicare Compliance & Reimbursement

Pharmaceuticals:

CAP Shouldn't Require Exact Date Of Drug Admin

Published on Wed Apr 27, 2005

Associations object to 'radical' change in drug-billing window.

Now that the Centers for Medicare and Medicaid Services has unveiled the details of next year's Competitive Acquisition Program for Part B drugs, physician associations are raising their concerns about the program. Comments submitted to CMS dealt with the following issues:
 
  •  The change from the current one-year window to submit claims for drug administration to a 14-day window after acquiring the drug is "radical" and  "will impose an excessive burden in many practice settings," says the American College of Physicians.
     
  •  CMS won't pay doctors separately for the clerical and inventory expenditures associated with participating in the CAP.
     
  •  CMS requires physicians to obtain all drugs listed in a particular category from a chosen vendor who participates in the CAP program.
     
  •  The regulation requires physicians to specify the date on which they'll administer a drug. If they don't administer it on that date, they must negotiate with the vendor what to do with the unused drug, ASCO notes.
     
  •  Physicians are locked into a single drug vendor for an entire year, complains the Community Oncology Alliance. Also, patients may have to return later for treatment because physicians will have to order drugs from vendors. 

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