CMS is directing Medicare administrative contractors (MACs) to instruct hospices to remove or omit from their claims certain oral anti-cancer and anti-emetic drugs until Jan. 1.
 
Bills have been inaccurately returned to provider (RTP’d) as a result of these kinds of drugs being listed, CMS says in Transmittal 1528/Change Request 9255, posted Aug. 6.
 
The Common Working File doesn’t currently permit certain anti-cancer and anti-emetic drugs to be included on bills from hospices. MACs discovered and reported the issue to CMS.
 
Affected claims aren’t being paid even though the reported drug services don’t change the amount being requested, Transmittal 1528/Change Request 9255 states.
 
The transmittal doesn’t identify which specific medications were affected or how widespread the problems were.
 
After CMS makes the system changes, hospices should be able to resume sending in claims that list those drugs, says Theresa Forster, vice president of hospice policy and programs for the National Association for Home Care & Hospice.
 
CMS would ultimately like hospices to resubmit claims that are being processed this year that don’t list those drugs; it wants the information for data purposes, Forster says.
 
In April 2014, CMS expanded its requirements for data on hospice claims. Since then, hospices have been required to report all prescription medications that they are providing as part of the hospice benefit.