MLN
Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare &
Medicaid Services) |
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Part B Information
MLN Matters Number: MM6053
Related Change Request (CR) #: 6053
Related CR Release Date: May 30, 2008
Effective Date: July 1, 2008
Related CR Transmittal #: R1520CP
Implementation Date: July 7, 2008
Part B Drug Competitive
Acquisition Program (CAP) Quarterly Drug Update
Provider Types Affected
Physicians billing Medicare Administrative Contractors
(A/B MAC) and carriers for Medicare Part B drugs, and approved
CAP vendors billing the designated Medicare A/B MAC or carrier
Impact on Providers
This article is based on Change Request (CR) 6053, which provides
notice that there will be a Part B CAP Quarterly Drug List
Update effective July 1, 2008. CR 6053 notifies the CAP designated
carrier, carriers, and A/B MACs of the processes necessary
for implementing the Part B CAP Quarterly Drug List Update
effective July 1, 2008.
Key Points of CR 6053
Background
Section 303 (d) of the Medicare Modernization Act requires
the implementation of a competitive acquisition program (CAP)
for Medicare Part B drugs and biologicals not paid on a cost
or prospective payment system basis. The CAP is an alternative
to the average sales price (ASP) (buy and bill) methodology
for acquiring certain Part B drugs which are administered
incident to a physician's services. Beginning with drugs administered
on or after July 1, 2006, physicians have a choice between
buying and billing these drugs under the ASP system, or obtaining
these drugs from the vendor selected in the competitive bidding
process.
Additional Information
For complete details regarding this CR please see the official
instruction (CR6053) issued to your Medicare A/B MAC, or carrier.
That instruction may be viewed by going to http://www.cms.hhs.gov/Transmittals/downloads/R1520CP.pdf
on the CMS Web site.
If you have questions, please contact your Medicare A/B MAC,
or carrier at their toll-free number which may be found at
http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip
on the CMS Web site.
Also, additional information on the CAP program is available
at http://www.cms.hhs.gov/CompetitiveAcquisforBios/
on the CMS Web site.
Disclaimer This article was prepared
as a service to the public and is not intended to grant rights
or impose obligations. This article may contain references
or links to statutes, regulations, or other policy materials.
The information provided is only intended to be a general
summary. It is not intended to take the place of either the
written law or regulations. We encourage readers to review
the specific statutes, regulations and other interpretive
materials for a full and accurate statement of their contents.
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