MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
|
Minimum Number
of Drug Pricing Files That Must Be Maintained Online for
Medicare
|
This article was revised on December 15, 2004
to show that it does not apply to providers and
suppliers billing Durable Medical Equipment
Regional carriers (DMERCs).
|
Provider Types Affected
All
providers billing Medicare carriers for drugs
Provider Action Needed
None.
This change request is for your information only.
Background
Medicare is creating
a new minimum standard for the number of online drug
price determination files that your Medicare carrier will
maintain. The new minimum standard is eight fee
screens/pricing files (the current period and seven prior
files) for Part B (payment on a fee-for-service) drugs
that you bill.
Since January 1, 2003, Medicare carriers have paid
drug claims based on the prices shown on the Single Drug
Pricer (SDP) files. The Centers for Medicare &
Medicaid Services (CMS) is creating a new minimum
standard for the number of online pricing files
maintained by carriers for determining drug prices. The
new minimum standard is raised from five to eight fee
screens/pricing files for Part B drugs billed to carriers
and DMERCs for payment on a fee-for-service basis.
This will allow Medicare to be more precise in paying
the rate in effect at the time services are provided.
Additional Information
To view
the actual instruction issued to your carrier, go to:
http://www.cms.hhs.gov/Transmittals/
From that Web page, look for CR 3231 in the CR NUM
column on the right, and click on the file for that
CR.
If you have any questions, please contact your carrier
at their toll-free number, which may be found at:
http://www.cms.hhs.gov/MedlearnProducts/downloads/CallCenterTollNumDirectory.pdf
Disclaimer
Medlearn Matters articles are
prepared as a service to the public and are not intended
to grant rights or impose obligations. Medlearn Matters
articles 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.
For additional information, visit the Medlearn Matters
Web page at www.cms.hhs.gov/medlearn/matters
.
Related Change Request (CR) #:
3231
Medlearn Matters Number: MM3231 Revised
Related CR Release Date: August 3,
2004
Related CR Transmittal #: 269
Effective Date: January 1,
2005
Implementation Date: January 3, 2005
|
