Review of Oxaliplatin Billing at Parkland Health and Hospital System for the Period January 1 Through December 31, 2005

摘要

Pursuant to Title XVIII of the Social Security Act, the Medicare program provides health insurance for people age 65 and over and those who are disabled or have permanent kidney disease. The Balanced Budget Act of 1997, P.L. No. 105-33, authorized the implementation of an outpatient prospective payment system (OPPS) effective August 1, 2000. Under the OPPS, Medicare makes additional temporary payments, called transitional pass-through payments, for certain drugs, biologicals, and devices. Oxaliplatin is a chemotherapy drug used to treat colorectal cancer. Outpatient hospitals received transitional pass-through payments for oxaliplatin furnished to Medicare beneficiaries from July 1, 2003, through December 31, 2005. Medicare required hospitals to bill one service unit for each 5 milligrams of oxaliplatin that a beneficiary received. Parkland Health & Hospital System (Parkland) is an acute-care hospital in Dallas, Texas, that has 985 Medicare-certified beds. We reviewed three oxaliplatin payments to Parkland for services provided to two Medicare beneficiaries during calendar year (CY) 2005.