At the 14th Annual ASIPP meeting in Washington, D.C., June 8-10, 2012, my team had the opportunity to discuss CMS billing with one of the conference’s faculty members ““ a specialist on medical coding/billing and compliance. According to this source, CMS is aware of the issue where pharmacies are billing Medicare for implanted drug pump medication provided “incident to” a physician service “¦ and mandates have been developed by CMS, just not yet enforced.

This billing specialist stated that CMS plans to implement the mandate effective January 1, 2013 ““ which would prohibit pharmacies from billing Medicare for implanted drug medications. Currently, whether these claims are denied or not denied depends on the region where they are submitted. Throughout a majority of the U.S., these claims are denied by Medicare, but pharmacies in a few regions are able to receive reimbursement. According to our source’s expert opinion, there is no question of “if” CMS will prohibit pharmacies from submitting billing for implanted drug pumps in this manner, but “when” it will be instituted. This sentiment was reiterated at the International Academy of Compounding Pharmacists Annual Meeting in Washington, D.C.

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If you are not fully aware of the CMS billing issue, visit our past blog articles entitled Is Change Coming? Medicare Billing for Implanted Drug Pumps and A CMS Billing Update.

For more information about Medicare reimbursement, visit Hartley Medical’s Knowledge Center by clicking here.