tci Medicare Compliance & Reimbursement - 2003 Issue 17

Medicare Pass-Through: ANEMIA DRUG DISPUTE FILLS CMS MAILBAG

Both Republicans and Democrats are criticizing the way the Centers for Medicare and Medicaid Services determines which outpatient drugs are eligible for extra payments designed to encourage the use of new technologies while their costs are being incorporated into the appropriate hospital outpatient prospective payment system reimbursement category. In its 2003 OPPS rule, CMS declared that a drug would not be eligible for pass-through payments if it was "functionally equivalent" to an existing medication. In recent months, agency head Tom Scully has been the recipient of a bipartisan series of letters complaining that this standard did not appear in...

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