NEWSThe Centers for Medicare & Medicaid Services (CMS) has released the final National Coverage Determination (NCD) for Erythropoesis Stimulating Agents (ESA). It is effective 7/30/2007, and its implementation date is 4/7/2008. The NCD is a result of a Change Request. The Change Request is the document that CMS has issued to Medicare contractors to provide direction concerning the implementation of the National Coverage Decision. Please refer to the NCD for additional information that may supercede the Medicare guidelines provided by your local Medicare Carrier, Fiscal Intermediary, or Medicare Administrative Contractor (MAC). To view the NCD, click here or to visit the CMS ESA policies page click here. Contact your Medicare Contractor (Carrier, Fiscal Intermediary, or MAC) or PROCRITline (1-800-553-3851) for additional information.
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Resources to help patients or caregivers learn more about treatments or financial programs.
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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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- 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 Med Learn Matters article.
- CMS Reporting Requirements for ESAs Effective 1/1/08
- Effective for all claims requesting payment for the administration of ESAs with dates of service on and after January 1, 2008, CMS requires that the most recent hematocrit and/or hemoglobin levels be reported, along with one of three designated modifiers. Click here for the associated Med Learn Matters article related to the Change Request 5699. For more information click here for Change Request 5699, or on these links for sample CMS 1500 and CMS 1450 forms.
- Competitive Acquisition Program (CAP) 2008 (Updated)
- The CAP Physician Open Enrollment period took place between October 1, 2007 and November 15, 2007. All physicians who wish to participate in the CAP between January 1, 2008 and December 31, 2008 should have submitted a Physician Election form to their local carrier between October 1, 2007 and November 15, 2007. Physicians who are new to Medicare may submit an application during the first 90 days of their Medicare participation. All current Participating CAP Physicians who are interested in continuing with the program for 2008 are required to renew their CAP election. Noridian Administrative Services is the CAP designated carrier. Click on these links for more information: CAP Drug List, Sample CMS 1500 Example for PROCRIT, 2008 CAP Physician Election Guide and CAP Physician Election Agreement. Contact your Medicare Contractor (Carrier/FI/MAC) or PROCRITline (1-800-553-3851) for additional information or click here for the Program Details at the CMS website.
- 2008 Physician Quality Reporting Initiative (PQRI)
- The Physician Quality Reporting Initiative (PQRI) will continue throughout 2008. PQRI establishes a financial incentive for eligible professionals to participate in a voluntary quality reporting program. For 2008 there are new measures and new documentation requirements. All information including the complete specifications for the 119 measures is available from CMS by clicking here. Refer to the ESA information in the 2008 PQRI Quality Measure Specification document to learn more about the documentation requirements for 2008. Refer to measure 123 for CKD information. Contact your Medicare Contractor (Carrier or MAC) or PROCRITline (1-800-553-3851) for additional information. For a sample CMS 1500 form, click here.
- 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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