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Resources to help patients or caregivers learn more about treatments or financial programs.
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Publications and toolkits for billing professionals regarding reimbursement issues and processes.
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Over 400 links to societies and state sites that will help with reimbursement, insurance or specific patient needs.
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- Key Deadlines Updated for Providers Transitioning Out of CAP
- On November 26, 2008, the Centers for Medicare & Medicaid Services (CMS) updated guidance on claims-submission deadlines and unused drugs for physicians transitioning out of the Medicare Part B Competitive Acquisition Program (CAP). For more information click here.
- Physician Fee Schedule Changes for 2009
- As a result of Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), many physicians likely expected a 1.1 percent increase in overall payment for Medicare services in 2009. For more information click here.
- Medicare OPPS for 2009
- Most separately payable Medicare Part B-covered drugs that are administered by physicians in the hospital outpatient setting will be reimbursed at a rate of ASP plus 4 percent in 2009. For more information click here.
- PQRI Continues for 2009
- Medicare providers who participate in the Physician Quality Reporting Initiative (PQRI) in 2009 will be eligible for incentive payment of up to 2 percent. For more information click here.
- Recovery Audit Contractors (RACs)
- On November 3, 2008, CMS announced a delay in the Recovery Audit Contractors (RAC) program because of protests filed by two unsuccessful bidders with the Government Accountability Office (GAO). That resulted in CMS halting the contract work of four RACs that the agency named on October 6, 2008, pending a decision by the GAO. A decision is expected by early February 2009. For more information click here.
- Electronic Billing for ESAs
- Effective January 1, 2008, the hemoglobin and/or hematocrit must be reported on all claims for ESAs & anti-anemia drugs used in the treatment of cancer. For professional electronic claims (837P) billed to carriers or to Part A/Part B Medicare Administrative Contractors (MAC), providers are to report the hemoglobin or hematocrit readings in Loop 2400 MEA segment. For more information click here.
- National Drug Codes for Medicaid Claims Submissions
- The Deficit Reduction Act (DRA) of 2005 required State Medicaid Agencies to provide for the collection of National Drug Codes (NDCs) for certain physician administered drugs. This requirement became effective 1/1/07. Medicaid claims now require the use of NDCs on the CMS 1500 form. Click here to read the MLN Matters article for further information.
- CMS Clarifies Starting Dose Limits for ESA Treatment
- The starting dose for ESA treatment is up to either of the recommended Food and Drug Administration (FDA) approved label starting doses for cancer patients receiving chemotherapy, which includes the 150 U/kg/3 times weekly or the 40,000 U weekly doses for epoetin alfa. For more information click here for the CMS MLN Matters article.
- Carrier/FI/MAC Changes
- The Centers for Medicare & Medicaid Services (CMS) is integrating the administration of Medicare Parts A and B for the fee-for-service benefit to new entities called Medicare Administrative Contractors (MACs). To learn more about the status of this program in your state, click here
- Subscribe to E-mail Alert Service
- Sign up for our e-mail alert service that will let you know when PROCRITline.com has summary guideline updates, new information or features. This service will keep you on top of the latest changes here at PROCRITline.com. To subscribe click here.
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