Speakers Designed For Shipping Information Written Materials Print an order form: If you do not wish to place your order online, click here to download a printable order form (PDF file), then submit your order via fax or mail, as directed on the form.

Order Now (Secure Site) CD and Printed Materials ($292) Pub code: CMDVBT View Cart

CMS is yet to provide health plans, pharmacies, providers, and beneficiaries with the practical guidance they need to end the Part D vs. Part B confusion. The agency issued draft guidance in July 2005 that addressed some of these D vs. B complexities, but that document has never been finalized.

With this lack of clarity, there are some drug categories that are considered "gray zones," under which drugs (e.g., oral anti-cancer drugs, home infusion drugs, immunosuppressives) can potentially be covered under Part D or Part B, depending on circumstances. Pharmacists are confused about whether to bill these drugs under Part D or Part B, and neither pharmacists nor Part D sponsors know whether a drug is being billed correctly.

Many Medicare drug plan sponsors are simply guessing at how to code and bill for drugs that fall in these gray zones. But accurate coding and billing are crucial, since plans that incorrectly shift costs between Part B and Part D potentially risk losing thousands of reimbursement dollars per drug claim. Additionally, patterns of incorrect or inappropriate billing could inadvertently reduce the amount of risk-adjustment payments plans receive from CMS, result in inaccurate beneficiary cost sharing, and/or potentially expose plans to CMS audits and allegations of Medicare fraud, waste, and abuse.

Listen in as three of the nation's leading experts in Medicare and Part D — including Babette Edgar, vice president of strategic development at Gorman Health Group and a former CMS official — discuss how to determine the correct coverage for Part B-only drugs, Part D-only drugs, and D vs. B "crossover" drugs. You will hear the specifics on which circumstances trigger coverage under Part D vs. Part B, along with appropriate coding information, for the drug types that are the most problematic to decipher — those used in conjunction with durable medical equipment, immunosuppressive agents, hemophilia clotting factors, and oral anti-cancer drugs.

This presentation will help you navigate the complexities of:

Speakers

BABETTE S. EDGAR, Pharm. D., MBA is vice president of strategic development at Gorman Health Group, where she specializes in formulary management, benefit design, utilization management, disease management and marketing for the Medicare Part D drug benefit and commercial managed care market segments. Prior to joining GHG, Dr. Edgar was the director of the Division of Finance and Operations for the Medicare Drug Benefit Group at CMS, where she directed building and implementing the formulary and benefit design review processes for the Part D drug benefit.

SHARON M. DURFEE, R.PH., BCNSP is an infusion therapy specialist and a senior pharmacy benefits consultant at Gorman Health Group. Currently she is the chair of the task force to revise and update the ASPEN Standards for Specialized Nutrition Support for Adult Residents of Long Term Care Facilities. These standards will be published in Nutrition in Clinical Practice. She has been on the board of directors for the Colorado Society for Parenteral and Enteral Nutrition for many years. Ms. Durfee is also a member of the Board of Pharmaceutical Specialties, Specialty Council on Nutrition Support Pharmacy and was recently elected vice chair of the council.

WENDY WEINGART, R.PH., MS is a senior consultant at Gorman Health Group with more than 16 years of health plan and managed care pharmacy practice, as well as extensive hospital and retail experience. Additionally, she also held faculty appointments at the University of Wisconsin-Madison School of Pharmacy as a Clinical Assistant Professor and at the University of Wisconsin-Parkside and Carroll College/Columbia College Schools of Nursing as a Pharmacology Instructor and Course Coordinator. Most recently, Ms. Weingart worked at Assurant Health (formerly Fortis Health), a leading health plan specializing in group and individual medical markets throughout the U.S.

Moderator: Barbra Golub, managing editor of AIS's Medicare Part D Compliance News

Designed Especially For

Shipping Information

Audio CDs and written materials are shipped via UPS. Please give us your street address when you order (UPS does not deliver to PO boxes). You should receive your order within 5-7 business days.* Shipping cost is $5.

Rush Orders: Please call us at 800-521-4323 to place a rush order.* We will overnight your order for an additional charge of $30, or you can give us your FedEx or UPS account number and we will charge the shipping to your account. Rush orders placed after 3:00pm EST will not be shipped out until the next business day.

Written Materials