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News You Can Use: Secure Extra Payment for New Cancer Drug

Injectable treatment earns pass-through reimbursement

3 surefire tips to proper Velcade billing
You can now earn pass-through payment for one more drug: New injectable medication Velcade, used to treat multiple myeloma (a blood cancer), earns pass-through reimbursement for any services performed after Oct. 1, 2003. When billing for services prior to Oct. 1, report the administration with HCPCS code J3490 (Unclassified drugs). For dates of service after Oct. 1, use C9207 (Injection, bortezomib, per 3.5 mg).
Remember these three tips when billing Velcade:
 
 - If you want pass-through payment for code C9207, and you reported it on claims that also include codes for additional services performed between Oct. 1 and Dec. 1, 2003, you should nix the C9207 and just submit the other services. You can submit an adjustment bill in January 2004 for the Velcade administration. 
 
 - Play it safe, CMS states, and wait to submit Velcade billing performed post-Oct. 1 until the Jan. 1, 2004, effective date for pass-through.
 
 - Already submitting Velcade claims for services post-Oct. 1 without using code C9207? No sweat - just send in an adjustment claim after Jan. 1 to earn pass-through payment.
Hospitals, put your pens aside with new Medicare reform bill
If you're drowning in Medicare's administrative quagmire, take heart: Congress has thrown you a lifeline. Buried in the thousands of pages that make up the newly enacted Medicare Prescription Drug, Improvement and Modernization Act of 2003 are  regulatory reform provisions that could ease providers' administrative burdens.
President George W. Bush signed the provisions, gathered under the "Regulatory Reform" heading under Title IX of the bill, into law on Dec. 8 along with the rest of the bill. Probably the most helpful provision will be the one allowing providers simply to correct minor technical errors on claims without going through the timely and costly full-blown appeals process, says Kathy Thompson of the Visiting Nurse Associations of America.
 
The Department of Health and Human Services will work with both its Medicare contractors and provider representatives to further develop a process that will allow those simple corrections to take place, according to Section 937. The new process should be in place by December 2004, the bill indicates. Among the host of changes, the following provisions are particularly helpful:
 
Overpayments (Section 935). Medicare is now restricted from recouping overpayments until a reconsideration decision on the matter is rendered - in other words, until the provider has exhausted the options in the first level of appeals. 
 
Appeals for dead patients (Section 939). This provision, which took effect upon enactment, allows providers and suppliers to appeal claims determinations when a patient dies and there is no other party to take up the appeal.
 
Extrapolation limits (Section 935). Medicare is [...]

- Published on 2004-01-02