Ashtabula County Medical Center Incorrectly Billed Medicare for Leuprolide Acetate Implants.

摘要

Leuprolide acetate, a drug used in the treatment of advanced prostate cancer in men and the management of other medical conditions in women and children, may be administered as an implant or an injection. Leuprolide acetate implants are inserted into the patients upper arm and provide continuous treatment for advanced prostate cancer for 12 months. Providers bill Medicare 1 unit of service for each 65-milligram implant. Leuprolide acetate (for depot suspension) injections are administered to patients using a prefilled syringe that provides treatment for either 1 month (7.5 milligrams), 3 months (22.5 milligrams), 4 months (30 milligrams), or 6 months (45 milligrams). Providers bill Medicare 1 unit of service for each 7.5 milligrams administered. Therefore, leuprolide acetate implants billed for more than one unit or more than once in a 12-month period may represent incorrect billing for the injected drug. Title XVIII of the Social Security Act established the Medicare program to provide health insurance for people aged 65 and over and individuals with disabilities or permanent kidney disease. Part B of the Medicare program provides supplementary medical insurance for medical and other health services, including outpatient services such as implanted and injected drugs. The Centers for Medicare & Medicaid Services (CMS), which administers the program, contracts with Medicare contractors to process and pay Medicare claims submitted for outpatient services. Medicare contractors use the Fiscal Intermediary Standard System and CMSs Common Working File (CWF) to process claims.