CMS urges PDPs to use standardized codes
Executive Briefings Digest, April 18, 2006
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Medicare Part D prescription drug plans (PDPs) should adopt the use of standardized "patient locator codes," which will facilitate the electronic processing of claims for long-term care residents, the Centers for Medicare & Medicaid Services (CMS) said in February 2006.
CMS urged the PDPs to adopt the National Council for Prescription Drug Programs' standardized coding procedure. The codes identify beneficiaries living in nursing homes and assisted living facilities. According to the American Health Care Association, PDPs that use the codes will
- correctly indicate no copayments for dual-eligibles in long-term care facilities
- eliminate much of the confusion around which drugs are paid for under Part B versus Part D
- apply the long-term care facility transition period provided by the PDP
- determine whether special unit dose packaging is payable under the beneficiary's plan
Source: Billing Alert for Long-Term Care
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