Proposed Change

• CMS Proposes Change to the Reimbursement Methodology for Inpatient "Add-on" Payments for Blood Clotting Factors
• Proposed Change

The CMS proposed ruling for the Inpatient "add-on" payment for blood clotting factors is consistent with current reimbursement under the Medicare Part B Program. Beginning January 1, 2005, as promulgated within the Medicare Modernization Act of 2003 (MMA), blood clotting factors are now reimbursed based on an Average Sales Price (ASP) plus 6%. Blood clotting factors also receive an additional $0.14 per unit "furnishing fee" for the administration costs associated with the dispensing and management for such therapies.

CMS is now proposing a consistent methodology for reimbursing blood clotting factors under the Medicare Part A Program. This will incorporate the ASP plus 6%, plus the $0.14 per unit to pay for the Inpatient "add-on" payment for blood clotting factor therapies. As with the reimbursement under Medicare Part B, the Inpatient "add-on" payment for blood clotting factors will be updated on a quarterly basis, with the $0.14 per unit furnishing fee to be updated annually based on the Consumer Price Index (CPI).

The proposed ruling for the IPPS can be viewed by accessing the following link: http://www.cms.hhs.gov/AcuteInpatientPPS/IPPS/list.asp. CMS will accept comments on the proposed ruling in one of three ways:

• Electronically: http://www.cms.hhs.gov
  
  
• By Mail:
  Centers for Medicare & Medicaid Services
  Payment for Blood Clotting Factor Administered to:
  Hemophilia Inpatients
  Attention: CMS-1500-P
  P.O. Box 8011
  Baltimore, MD 21244-1850
  
  
• By hand or courier (one original and two copies).
  
  Call (410) 786-7195 in advance to schedule your arrival with one of the CMS staff:
  
  Room 445-G, Hubert Humphrey Building
  200 Independence Avenue, S.W.
  Washington, DC 202011
  - or -
  7500 Security Boulevard
  Baltimore, MD 21244-1850
  

Comments will be considered if received at the appropriate address, no later than 5 p.m. on June 24, 2005. If you have further questions related to this article, feel free to contact ZLB Behring’s Reimbursement Answerline, Toll-Free, at 1-800-676-4266.

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Reimbursement Alert May 2005

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