2009-07-09

On June 30, the Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) released a report on Medicare Part B drug administration. The objective of the report was to determine whether Medicare paid appropriately for Part B services billed as chemotherapy administration from 2005 to 2007. OIG's findings were inconclusive finding the data insufficient to determine consistently whether chemotherapy administration payments are appropriate.

OIG was critical of the Centers for Medicare and Medicaid Services policy of letting local carriers determine which drugs qualify for billing with the chemotherapy administration codes. OIG concluded that this has led to inconsistencies in how much carriers pay for the administration of certain drugs and recommended the following actions for CMS:

• Establish a process to determine which specific drugs qualify for the chemotherapy administration payment rate
• Instruct carriers that have not done so to consider a probe review of unmatched chemotherapy administration claims
• Ensure that drug administration claims are coded correctly are paid appropriately

CMS voiced a mixed response to these recommendations.

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