Medicare Compliance & Reimbursement

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.