Your patient-specific order would trigger drug delivery under CAP

Why This Topic Matters

The guidance affects how practices request, receive, document, and bill for Medicare Part B drugs under CAP. Understanding the workflow is important for avoiding claim problems, coordinating vendor-supplied drugs, and determining when alternative payment handling applies.

Article Sections

1. How the drug ordering process works

   This section describes the overall ordering workflow for patient-specific drug supplies under the CMS vendor program. It addresses the required transmission and documentation steps practices must follow.

2. Vendor supply and delivery timing

   This section explains the vendor’s delivery obligations and how timing varies for routine and emergency situations. It also covers vendor questions and limited circumstances affecting shipment.

3. Drug administration claims and payment workflow

   This section outlines the claim submission process for administration services and the coordination between practice claims and vendor claims. It also discusses system readiness for claim linkage and payment processing.

4. Emergency situations

   This section discusses how the program handles urgent situations when drugs must be administered before vendor delivery can occur. It also notes audit considerations and alternate billing treatment.

5. When CAP cannot be used

   This section summarizes categories of drugs and situations that fall outside the CAP option. It explains that some items must continue under the standard Medicare drug purchasing and billing approach.

6. Dispense as Written

   This section addresses circumstances involving a specific brand choice for a covered drug and the related billing pathway. It also notes documentation and review considerations.