tci Medicare Compliance & Reimbursement - 2004 Issue 28

COVERAGE: EPO Policy Gets A Check-up

Plans get creative to secure best deals while complying with antitrust laws. A draft revised policy from the Centers forMedicare & Medicaid Services issued July 8 could pave the way for smarter coverage of your end stage renal disease patients. But first CMS wants to hear your take. For potentially anemic patients, the draft policy would monitor: both hemocrit and hemoglobin levels; the incentives that exist to keep these levels in the 'target range'; and excessive dosing of erythropoietin. CMS currently restricts reimbursement for EPO claims to a post-payment review of beneficiaries who claim a rolling average hematocrit level...

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