Wednesday, March 4, 2020

CMS Warns of Incorrect Billing for Trastuzumab


Also, Long Term Hospital Adjustment to be Implemented this Summer


CMS announced last weekend that government auditors, upon reviewing claims data for Trastuzumab (Herceptin) for the last several years, found “numerous instances” of incorrect billing for multi-use vials in cases in which some of the medication was wasted.

The agency stated, “Multi-use vials are not subject to payment for discarded amounts of drug or biological,” and referred providers to Chapter 17, Section 40 of the Medicare Claims Processing Manual.

The Institute for Clinical and Economic Review announced last July that the breast cancer drug, trastuzumab deruxtecan, may be the subject of an ICER review this year.

CMS also announced that the Long Term Care Hospital (LTCH) Discharge Payment Percentage (DPP) Payment Adjustment will be “implemented” on July 6.

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