2006 ASP Drug Pricing Files

http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/02_aspfiles.asp#TopOfPa

Medicare Part B for 2007 For CY 2007

The following rates are applicable for Medicare Part B Deductible and Coinsurance:
Deductible $131.00 per year
Coinsurance 20 percent

November

November 16, 2006

• REMINDER: The physician election period for the 2007 Medicare CAP will conclude on November 15. 
  
  The physician election period for the 2007 Medicare Part B Drug Competitive Acquisition Program (CAP) will conclude on November 15, 2006. Completed and signed physician election forms should be returned by mail to your local carrier. Forms must be postmarked on or before November 15, 2006.  The CAP is an alternative to the Average Sales Price (ASP) method of acquiring many drugs and biologicals administered incident to a physician’s services.
  
  Additional information about the CAP is available at http://www.cms.hhs.gov/CompetitiveAcquisforBios/01_overview.asp .
  
  Additional information about the 2007 CAP physician election process is at http://www.cms.hhs.gov/CompetitiveAcquisforBios/02_infophys.asp .
  
  The list of drugs supplied by the CAP vendor, including NDCs, is in the Downloads section at http://www.cms.hhs.gov/CompetitiveAcquisforBios/15_Approved_Vendor.asp .
  
  CAP physician election is an annual process that provides an opportunity for physicians who are not participating in the CAP to join. Physicians who are currently participating in the CAP must submit an election form in order to continue participation or to terminate participation. Physicians who are not participating in the CAP and do not wish to participate in the CAP at this time are not required to take any action.  (CMS Message 200611-07) 
  
• Effective at the earliest, July 1, 2007, the carrier standard system for Medicare will automatically process all diagnosis codes you submit on your claims.  Read more about it in the MLN Matters Article titled "Processing All Diagnosis Codes Reported on Claims Submitted to Carriers" (CR 4276).
  
• The article on Top 10 Claims submission errors has been updated.
  
• Please review this new information on Appeals with a new address for the second level of appeal known as a Reconsideration.
  
• The Independent Diagnostic Testing Facility - Revised  LCD for California has been finalized and will be on the CMS web site on Thursday 11/16/06, under the future LCD index.  This LCD will become effective 1/1/2007. 
  
• CMS Article Numbering System for LCDs
  Effective November 16, 2006, a new numbering system will be used for the CMS LCD Article database.  The  “Article ID Number”, assigned by the CMS Medicare Article Database, will be uniform across California.

November 09, 2006

• This article notifies you about changes to the Medicare Claims Processing Manual, which ensure that claims with clerical errors (which include minor errors and omissions) should be processed as “reopenings” and not as “appeals.” (CR 4147)
  
• CMS provides the annual Home Health consolidated billing update effective January 1, 2007. (CR 5356)
  
• This article discusses Returning Paper Claims Received from Clearinghouses (CR 5341).
  
• A new educational article, Mandatory Electronic Claims Submission has been added.
  
• Training on the CMS-1500 Claim Form will be offered as a one-hour Ask the Contractor Teleconference (ACT) on December 14, 2006.
  
• The text version of the 2007 Fee Schedule Files has been posted to the California Fee Schedule Page.

November 07, 2006

• Medicare Part B Drug Competitive Acquisition Program (CAP): Physician election period for 2007 ends on November 15, 2006 All physicians and physician groups who wish to participate in the CAP during 2007 must submit a signed and completed Physician Election Agreement Form by mail to their local carrier. The form must be postmarked on or before November 15, 2006.
  
  This fall’s CAP physician election process provides an opportunity for physicians to join the CAP for 2007. Physicians must elect to participate in the CAP program annually; therefore physicians currently participating in the CAP must go through the election process in order to affirm their participation for 2007 or to leave the program at the end of 2006. Please note that physicians who are currently not participating in the CAP and who do not want to participate in the CAP are not required to fill out the Physician Election Agreement form or to take any other action.
  
  The CAP is an alternative to the Average Sales Price (ASP or “buy and bill”) system of acquiring certain drugs that are commonly administered incident to a physician’s services. Additional information about the CAP physician election process for 2007 may be found at the following CMS website http://www.cms.hhs.gov/CompetitiveAcquisforBios/02_infophys.asp#TopOfPage (JSM 07053)

November 02, 2006

• The October 2006 edition of the CERT newsletter has been posted.
  
• The following Active LCDs have been updated:

  1. External Counterpulsation (ECP) - Added the allowance of a second session of treatments2. Pulmonary Function Testing - Add ICD-9-CM V58.693. Oncotype DX Testing -Breast Cancer Prognosis - Add ICD-9-CM V86.0 They can be accessed from the Active Local Coverage Determination Index:
  
  NHIC, Corp. – Northern California – 31140

  NHIC, Corp. – Southern California – 31146
  

• Update to Medicare deductible, coinsurance, and premium rates for 2007. (CR 5345)
  
• This article announces the changes that will be included in the January 2007 release of the edit module for clinical diagnostic laboratory NCDs. (CR 5384)
  
• This article provides specific instructions for physicians to modify their current reporting guidelines and requires physicians to begin reporting, as of May 23, 2007, a National Provider Identifier (NPI) on claims for clinical diagnostic services purchased outside of the local carrier’s jurisdiction. (CR 5289)
  
• Updated Information Regarding the New Qualified Independent Contractor (QICs) (JSM 07037)
  
• The Skilled Nursing Facility Prospective Payment System Fact Sheet, which is the first in an upcoming series of payment fact sheets, is now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network.  To place your order, visit www.cms.hhs.gov/mlngeninfo, scroll down to “Related Links Inside CMS,” and select “MLN Product Ordering Page.” (CMS Message 200610-17)
  
• The Hospice Payment System Fact Sheet is now available in downloadable format on the Centers for Medicare & Medicaid Services Medicare Learning Network (MLN). To access the fact sheet, visit www.cms.hhs.gov/MLNProducts/downloads/HospicePaymtSysfctsht.pdf. Print versions of the fact sheet will be available from the MLN in approximately six weeks. (CMS Message 200611-03)

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October

October 26, 2006

• Only 7 months remain until the National Provider Identifier (NPI) compliance date. Over 1,300,000 NPIs have been issued so far --- do you have your NPI yet?  (CMS Message 200610-13)
  
• The Educational On-line courses for Fraud and Abuse  and Preventive Services have been updated to include the most current information.

October 19, 2006

• Guide to 2007 Medicare Part B Drug Competitive Acquisition Program (CAP) Physician Election Process. (JSM 06703)
  
• New listserv for physicians participating in the Medicare Part B Drug Competitive Acquisition Program (CAP). (CMS Message 200610-09)
  
• A reminder about Medicare Preventive Services provider education products. (CMS Message 200610-10)
  
• Effective October 18, 2006 the Medicare interest rate for overpayments and underpayments has been changed to 12.375 percent. Historical Data available . (CR 5297)
  
• The article on the revised Form CMS-1500, which accommodates the reporting of the National Provider Identifier (NPI), has been revised. (CR 5060)
  
• CMS publishes The Quarterly Provider Update on the first business day of each quarter. It is a listing of all non-regulatory changes to Medicare including Program Memoranda, manual changes, and any other instructions that could affect providers.
  
• CMS will be administering the 2007 Medicare Contractor Provider Satisfaction Survey (MCPSS) beginning in January 2007. The MCPSS is designed to measure provider satisfaction with and perceptions about the services provided to Medicare providers and suppliers. All FIs, RHHIs, Carriers, DMERCs, DME MACs and the A/B MAC will be included as Fee-for-Service (FFS) Contractors in the national administration of the survey. (JSM 07009)
  
• The Newsletter pages have been revised to make it easier to locate current and archived editions.
  
• The following LCDs were revised due to the annual ICD-9 CM update, effective 10/1/2006: Allergy Testing; Cardiovascular Nuclear Medicine; Cardiovascular Stress Testing; Echocardiography, Transthoracic and Transesophageal - Revised;  ECG (Electrocardiograms); Erythropoietin Analog; Flow Cytometry; MRA of the Abdomen, Pelvis and Chest; IVIG - Intravenous Immune Globulin; Pulmonary Function Testing -Revised; Radiologic Exam, Chest; and Vestibular Function Testing. All of these can be accessed from the NHIC Active LCD Index on the CMS Website:

  NHIC, Corp. – Northern California – 31140

  NHIC, Corp. – Southern California – 31146

• The Questions and Answers from the National Provider Identifier (NPI) ACT have been posted.
  
• New quarterly Customer Service FAQs have been added.
  

October 12, 2006

• Emergency Preparedness Communication (CR 5336)
  
• The 2007 Fee Schedules will be placed on this website after the 2007 Physician Fee Schedule Regulation is put on display in mid-November. (CR 5307)
  
• This updates the Medicare Claims Processing Manual (Publication 100-04) for ending the contingency plan for Electronic Remittance Advice (ERA), and instructs contractors about possibly charging for PC Print, Medicare Remit Easy Print (MREP), and duplicate Remittance Advice (RA). (CR 5308)
  
• This article amends the payment files (based upon the November 21, 2005 Medicare Physician Fee Schedule Final Rule) that were previously issued. (CR 5272)
  
• New NPI Educational Products Available (CMS Message 200610-07)

October 05, 2006

• This article summarizes key requirements for submission of claims for the administration of drugs under the CAP. Following these requirements will allow correct and timely processing of your claims. (SE0672/JSM 06706)
  
• October is National Breast Cancer Awareness Month (NBCAM) ~ In conjunction with NBCAM, the Centers for Medicare & Medicaid Services (CMS) would like to invite you to join with us in helping to promote increased awareness of the importance of early detection of breast cancer, and ensure that all eligible women with Medicare know that Medicare provides coverage of screening mammograms and clinical breast exams for the early detection of breast cancer. (CMS Message 200610-02)

• The following billing guides have been updated: 1500 Claim Form Instructions, Fraud and Abuse Guide, General Surgery Billing Guide,  Introduction to Medicare, Medicare Secondary Payer - MSP, Non-Physician Practitioners, and Preventive Services Billing Guide,
  
• The Allowance Limits for Medicare Part B Drugs for Oct 1- Dec 31 have been posted. Also revised Allowance Limits for Medicare Part B Drugs for the past quarters have been posted. All of these can be accessed on the Fee Schedule page.
  
• The September 2006 edition of the CERT newsletter has been posted.
  
• The article on HPSA/PSA Update has been revised.
  
• A new educational billing article entitled: Focus on... Services Denied When Performed During the Same Session/Date as a Previously Processed Service has been posted. Many other articles have been updated. Refer to the Educational Articles page.
  
• The following new draft LCD will be presented at the October 18, CAC Meeting: Balloon Sinuplasty. It can be accessed on the CMS website under the DRAFT LCD index at:

  NHIC, Corp. – Northern California – 31140

  NHIC, Corp. – Southern California – 31146