Compliance Question of the Week – Pharmacy

Last week you provided information related to billing Medicare for the mixing of commercial products. What are the billing rules for compounding when the drugs are not a mix of commercially available products?

How should hospitals report (to Medicare) commercially available products that are mixed together to be administered simultaneously?

Under the OPPS, what’s included in payment for drugs and biologicals?

If a drug we have used is packaged by Medicare for payment, do we have to report it on our claims?

Do you know whether the rates for Part B covered drugs have decreased or increased for 2018?

Is the 2018 ASP file available yet?

Is whole blood covered under Medicare’s incident-to policy?

Does the incident-to policy affect Medicare payment for drugs?

What is the modifier to report with level II codes J0881 and J0885?

Are there any changes for 2018 related to skin substitutes?

I am looking for Medicare billing instructions for calcimimetics delivered for AKI in an ESRD facility. Do you know where this information can be found?

Is it appropriate for a pharmacy to use modifier KX when billing DME MACs for immunosuppressive drugs provided to Medicare beneficiaries who received an organ transplant that was paid for by Medicare?