E/M Coding Alert - 2005 Issue 25
Drug Acquisition: CMS Puts On Its Thinking CAP - And Puts Off Providers
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Article Overview
This article covers CMS’s interim final rule for the Competitive Acquisition Program (CAP) for Part B drugs and explains why the change matters to physicians and other providers who may participate in the program. It summarizes the broad structure of the program, the types of drugs and related items included or excluded, and the general process CMS describes for handling potential coverage disagreements. The piece is relevant to medical practices, especially oncology and other specialties that administer Part B drugs incident to physician services.
Why This Topic Matters
Providers considering participation in CAP need to understand how CMS’s updated timing and ordering framework may affect workflow, drug acquisition, and coverage disputes. The article also helps readers gauge which drug categories are addressed by the program and which are excluded.
What You Will Learn
- How CMS revised the Competitive Acquisition Program for Part B drugs
- What categories of drugs are addressed by the program
- How coverage concerns may be handled between vendors, physicians, and carriers
- Why the update is significant for practices that administer drugs incident to physician services
Who Should Read This
- Physicians
- Medical practices
- Oncology practices
- Billing and coding professionals
- Practice administrators
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