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From CMS: Reminders for ESRD Facilities/Physicians/Practitioners Who Receive MCPs
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The following reminders are for End Stage Renal Disease (ESRD) facilities and physicians and practitioners who receive monthly Medicare payments to manage ESRD patients (MCPs) that pertain to the Centers for Medicare & Medicaid Services (CMS’s) requirements for ESRD beneficiaries to access ESRD-related drugs effective January 1, 2011. These requirements will ensure that patients receive their medications and that appropriate payment is made for their medications.

  • ESRD facilities must instruct patients to obtain their ESRD-related medications from ESRD facilities’ contracted pharmacies to ensure that pharmacies receive payment from the ESRD facilities and patients receive their medications with no financial obligation.

  • ESRD facilities must instruct physicians and practitioners who receive monthly Medicare payments to manage ESRD patients (MCPs) to direct their patients to use ESRD facility-contracted pharmacies to ensure that pharmacies receive payment from the ESRD facilities and patients receive their medications.

  • MCPs must indicate on an ESRD patient’s prescription if prescribed medications is NOT ESRD-related to ensure that payment for these non-ESRD-related medications can be made under Part D. ESRD patients may obtain covered Part D, non-ESRD related prescription drugs from a network pharmacy or an out-of-network pharmacy in accordance with Part D rules.

  • ESRD facilities must indicate on the ESRD claims, each ESRD-related drug (except for composite rate drugs) furnished to an ESRD patient either directly or through a prescription filled by a pharmacy.

  • ESRD facilities must use the AY modifier on the ESRD claims for each non-ESRD-related drug furnished to an ESRD patient.

  • ESRD facilities must instruct home dialysis patients currently under Method II, about any changes in the arrangements for ESRD-related home dialysis supplies on and after January 1, 2011.

  • ESRD facilities must instruct home dialysis patients currently under Method II, that patients no longer have any financial obligation to suppliers for ESRD-related supplies on and after January 1, 2011.

(Message received by e-mail from CMS on Dec. 23, 2010)
 
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