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ASP Update on Aranesp

by Sandy Victor

If you use Aranesp, Medicare adjusted the ASP for all 3 previous quarters of 2007 as of October 1st.

For the 1st 2 quarters there is a substantial increase in the ASP. I contacted Sandy Victor of Empire to ask how to send these claims to Empire for the additional payment or if Empire would do an automatic adjustment. The following is her response:

The CR associated with the changes says:

  • The October 2007 Quarterly Average Sales Price (CR 5710), business requirement 5710.2 says:
  • 5710.2 Contractors shall not search and adjust claims that have already been processed unless brought to their attention.

Therefore, you will have to come in to Medicare with this as a REOPENING. This is very important that you indicate reopening rather than review/redetermination.

If you use the review form cross out the word and prominently display reopening - say it as many times as you can. Send it to the same address or use a form that you devise. You will probably be doing a spreadsheet with the name of the patient, hic number, date of service, number of units billed, how much paid and how much more you want based on the new price.

I know this takes a lot of work. I guess you have to evaluate whether it is worth it and from what I hear it is worth it.

Sorry that we don't run it as an ad hoc but following CMS directions as quoted above.

Sandy Victor
Medicare Provider Outreach and Education Consultant

National Government Services
Phone: 609-826-5650
Fax: 609-826-5699

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