CAP: GI practices must decide whether to join or keep billing for Remicade

Why This Topic Matters

Practices that administer high-cost injectable drugs must decide how to handle purchase, billing, and patient balance-related administration under Medicare. The article outlines a payment structure that can alter workflow, vendor relationships, and claim submission requirements for GI offices.

Article Sections

1. CAP and Medicare drug billing choices for GI practices

   Introduces the Medicare payment option discussed in the article and frames the decision facing practices that administer injectable medications in office. Covers the operational context for gastroenterology offices and the broader administrative implications.

2. How the program changes purchasing, vendor, and claim workflow

   Describes the general structure of the program, including advance drug ordering, use of a designated vendor, and the additional claim-related administrative steps involved. Also notes the relationship to Medicare billing responsibilities.

3. Practical considerations for low-volume practices

   Summarizes the article's discussion of which kinds of practices may find the option more suitable based on infusion volume and administrative burden. Focuses on workflow tradeoffs rather than clinical detail.

4. Coverage and claim-payment linkage

   Explains the article's point that coverage decisions affecting administration services can also affect associated drug payment under the program. Addresses the general connection between local coverage determinations and related billing outcomes.