2009 CAP Postponement

On September 10, 2008, the Centers for Medicare & Medicaid Services (CMS) announced the postponement of the 2009 Medicare Part B Competitive Acquisition Program (CAP).  The program will continue through December 31, 2008.

Earlier this year, CMS accepted bids for vendor contracts for the 2009-11 CAP.  While CMS received several qualified bids, contractual issues with the successful bidders resulted in CMS postponing the 2009 program.  As a result, CAP physician election for participation in the CAP in 2009 will not be held, and CAP drugs will not be available from an approved CAP vendor for dates of service after December 31, 2008.  

Later this fall, CMS will provide additional guidance for participating CAP physicians on how to transition out of the program. This information will be posted on the CMS CAP Physician's page.

CMS also plans to seek feedback on the CAP from participating physicians, potential vendors, and other interested parties. CMS will assess the information and consider implementing changes to the CAP before proceeding with another bid solicitation.  As part of the process, CMS is interested in hearing from the public about a range of issues, including, but not limited to, the categories of drugs provided under the CAP, the distribution of areas that are served by the CAP, and procedural changes that may increase the program's flexibility and appeal to potential vendors and physicians.

Information about how to submit comments will be available on this website. 

CAP Physician "Ask-the-Contractor" Teleconference for Providers on September 18, 2008 – PHONE NUMBER CHANGE

The Centers for Medicare & Medicaid Services (CMS) will host an "Ask-the-Contractor" teleconference on September 18, 2008 to discuss the postponement of the CAP for 2009 and to assist participating CAP physicians in planning for the transition out of the program.  The call will be conducted by the CAP designated carrier, Noridian Administrative Services (NAS).  NAS staff will be available to respond to inquiries during a question and answer session after the presentation.  This call is intended for all interested providers and their staff.

Call Details:

Title: Competitive Acquisition Program (CAP) for Part B Drugs and Biologicals – Transitioning Physicians out of CAP
Date and Time: September 18, 2008 at 2:00PM CST
Domestic U.S. Call Number: (800) 398-9397
U.S. Territories Call Number: (612) 332-0226

A PowerPoint slide presentation to accompany the "Ask-the-Contractor" teleconference will be posted on the NAS website at least one day prior to the teleconference.  The NAS website can be accessed via the 'Related Links Outside CMS' section below.

CAP Physician Billing Tips" Handout for Submitting CAP Claims

An updated version of the "CAP Physician Billing Tips" handout is now available.  This reference contains information on the claims submission requirements for the CAP such as the CAP modifiers and other necessary elements. A copy of this document is available in the 'Downloads' section below. 

October 1, 2008 CAP Drug List Update

The following drug will be added to the CAP drug list effective October 1, 2008: Vivitrol® naltrexone (J2315).  The updated CAP drug list, entitled "October 2008 List of Drugs Supplied Under the CAP, Corresponding NDCs, and Vendor VIN," is now available in the 'Downloads' section of this page.

Participating CAP Physician Training

Noridian Administrative Services, the designated carrier for the CAP, offers interactive, online workshops about the CAP for Part B Drugs and Biologicals. These workshops train CAP vendors and elected physicians on a variety of CAP topics, and NAS staff can also answer questions.  Interested parties may view additional information about and register for these workshops at the Register for CAP Physician Workshops link (in the Related Links Outside CMS section below.)

An upcoming workshop will be held on the following date:

• 8/21/08 at 2:00 pm CST

Post Payment Review and Medical Record Requests

The post-payment review process for the CAP is conducted to verify drug administration for Medicare claims submitted by an Approved CAP Vendor. For this process, a small sample of physician and Vendor claims and other documentation is examined in order to establish that drugs billed by an Approved CAP Vendor were administered and were medically necessary.

To support this review, participating CAP physicians may receive a request for copies of medical records from the CAP designated carrier, Noridian Administrative Services (NAS).  Medicare requirements and the CAP Terms of Agreement require participating CAP physicians to submit all information necessary to support the services billed on claims.

Participating CAP physicians must submit medical records to NAS within the requested timeframe.  This submission should include the patient's drug administration record and all other records supporting medical necessity for the drug.  If CAP post payment review activity cannot establish that a drug was administered, then the vendor's drug claim will be denied. The associated physician drug administration claim will also be referred to the physician's local carrier for review and recoupment as necessary.

For additional information on the post payment review process, please visit NAS's website via the 'Related Links Outside CMS' section below.

July 2008 CAP Drug List Update 

The updated CAP drug list, entitled "July 2008 List of Drugs Supplied Under the CAP, Corresponding NDCs, and Vendor VIN," is now available in the 'Downloads' section of this page.  The following drugs have been added to the CAP drug list effective July 1, 2008: Vectibix® panitumumab (J9303).  Descriptors for the CAP NOC drugs are at the bottom of the document. The list of NDCs available under the CAP has also been updated.

Systems Changes for Prescription Order Numbers for the Competitive Acquisition Program (CAP) for Part B Drugs and Biologicals

The Centers for Medicare & Medicaid Services (CMS) has recently changed the implementation date for certain Medicare Part B claims processing system edits that affect CAP claims.  Specifically, the implementation date has been changed from July 1, 2008 to July 7, 2008.  For additional information, please visit the "MLN Matters Articles" website via the 'Related Links Inside CMS' section below.  Search the '2008 MLN Matters Articles' for article #5855.

BioScrip Welcome Call

Physicians who elected to participate in the CAP during the January 15 to February 15, 2008 additional election period should have received a welcome telephone call from the Approved CAP Vendor, Bioscrip, Inc.

Physicians who have NOT yet received a welcome call and expect to participate in the CAP effective April 1, 2008 should contact their local carrier (the carrier that processes Part B drug claims) or Medicare Administrative Contractor (MAC) to inquire about the processing status of their physician election materials.  Local carriers' contact information may be found in the 'Related Links Inside CMS' section below under "Medicare Carrier Addresses."

Physicians may also contact the Approved CAP Vendor at (888)899-7447 to determine whether their information has been received.   Physicians may also request assistance from the CAP Designated Carrier, Noridian Administrative Services, at (888)671-0536 if their local carrier and the Approved CAP Vendor are unable to resolve their questions.

Please note that no action is required for physicians who did not submit a CAP physician election form during the 2008 CAP additional election period.

April 2008 CAP Drug List Update

The updated CAP drug list, entitled "April 2008 List of Drugs Supplied Under the CAP, Corresponding NDCs, and Vendor VIN List of Drugs," is now available in the 'Downloads' section of this page.  The following drugs have been added to the CAP drug list effective April 1, 2008: Orencia® abatacept (J0129), Boniva® ibandronate (J1740), Ixempra®  ixabepilone (Q4082 - NOC drug), and Somatuline® lanreotide (Q4082 - NOC drug).  Descriptors for the CAP NOC drugs are at the bottom of the document. The list of NDCs available under the CAP has also been updated.

2008 CAP Additional Election Period: One More "Ask the Contractor Teleconference" for New and Prospective CAP Physicians! February 13, 2008 at 2:00PM CST

The designated carrier for the Competitive Acquisition Program (CAP), Noridian Administrative Services (NAS), will hold one more 2008 Additional Physician Election Period "Ask the Contractor" Teleconference on February 13, 2008 at 2:00PM CST. New CAP Physicians can learn more about aspects of the program such as the CAP billing modifiers and billing for CAP claims. Prospective CAP physicians will have an additional opportunity to learn more about the CAP and how to elect into the program during the 2008 additional physician election period. The 2008 Additional Physician Election Period for the CAP concludes on February 15, 2008, so CAP staff will be available to respond to any general or last minute CAP election inquiries during a question and answer session after the presentation.

Call Number: (800) 700-8174

A PowerPoint slide presentation to accompany the "Ask-the-Contractor" teleconference will be posted on the NAS website at: https://www.noridianmedicare.com/cap_drug/train/act.html. The slides will be available at least one day prior to the teleconference (Tuesday, February 12).

Physicians can also contact the NAS CAP Vendor Contact Center at (888)671-0536 with question son the CAP election process or for general program inquiries.

2008 Additional Physician Election Period Ask the Contractor Teleconference on January 23, 2008 at 2:00PM CST

The designated carrier for the CAP, Noridian Administrative Services (NAS), will hold a teleconference on January 23, 2008 at 2:00PM CST.  Prospective CAP Physicians will have an opportunity to learn more about the CAP and how to elect into the program during the 2008 additional physician election.  Additionally, NAS staff will be available to answer questions. 

Call Number:     (888) 830-6260

Passcode:          463742

A PowerPoint slide presentation to accompany the 2008 Additional Physician Election Period teleconference will be posted on the NAS website at: https://www.noridianmedicare.com/cap_drug/train/act.html.  The slides will be available at least one day prior to the teleconference (Tuesday, January 22). 

The 2008 Additional Physician Election Period for the CAP will begin on January 15, 2008 and will conclude on February 15, 2008.

The 2008 CAP Drug List is now available

A copy of the updated "January 2008 List of Drugs Supplied Under the CAP, Corresponding NDCs, and Vendor VIN" can be obtained in the Downloads section below.

Additional CAP Physician Election Period for 2008

The CAP is a voluntary program that offers physicians the option to acquire many injectable and infused Medicare part B drugs they use in their practice from an Approved CAP Vendor.  New changes to the CAP have made it more flexible for physicians.  As of January 1, 2008, Participating CAP Physicians can now:

• File CAP drug administration claims within 30 days of administering CAP drugs
• request to leave the CAP within the first 60 days of election if program participation results in any burden to a practice (ex: difficulty meeting CAP drug ordering or billing requirements)
• request to leave the CAP after the first 60 days if an unexpected change in circumstance makes CAP participation a burden to a practice (ex: a change in patient population or practice personnel)

In order to give physicians a chance to take advantage of these new changes, an additional election period for the 2008 CAP will begin on January 15, 2008 and will conclude on February 15, 2008.  This additional election period is for physicians who are not currently participating in the CAP for 2008. Effective dates of participation for physicians who elect to join the CAP during this additional election period will be April 1, 2008 to December 31, 2008.

An additional election period for the 2008 Medicare Part B Drug Competitive Acquisition Program (CAP) will begin on January 15, 2008 and will conclude on February 15, 2008. The CAP is a voluntary program that offers physicians the option to acquire many injectable and infused drugs they use in their practice from an Approved CAP Vendor.

This additional election period is for physicians who are not currently participating in the CAP for 2008. Effective dates of participation for physicians who elect to join the CAP during this additional election period will be April 1, 2008 to December 31, 2008.

Physicians who are new to Medicare may elect into the CAP during this additional election period or may submit an application during the first 90 days of their Medicare participation. Current Medicare physicians may join CAP during this election period as well.

A physician's or a physician group's decision to participate in the CAP is voluntary. Please note that when members of a group practice bill Medicare using the group's Physician Identification Number (PIN), or National Provider Identifier (NPI), they commit as a group practice to participate in the CAP.

The physician election form can be found in the Downloads section below and may be filled out on-line and then printed for submission. The 2008 additional election period will use the same basic procedures and election agreement forms as previous election periods. Completed and signed forms must be submitted by mail to the local carrier that processes a given physician¡¦s Part B drug claims. Forms must be postmarked no later than February 15, 2008. Please do not mail in forms prior to January 15, 2008 or return completed forms to CMS. The CAP continues to serve one geographic area and has one approved vendor.

Additional details about the CAP physician election period are available in the 2008 CAP Physician Election Guide. The Guide is available in the Downloads section below. This section also includes a one page document entitled, "CAP Physician Election Tips."

The list of drugs supplied by the Approved CAP Vendor for 2008 is in the "Downloads" section of the "Approved CAP Vendor" web page.

We encourage all prospective and existing Participating CAP Physicians to become familiar with the CAP-specific resources available to them. Additional information about the CAP can be obtained from Noridian Administrative Services (NAS), the CAP Designated Carrier, at (888) 671-0536. A link to NAS may be found in the "Related Links Outside CMS" section below. Physicians may also contact their local Medicare carrier for other basic information about the CAP. Medicare local carrier contact information can be obtained via the "Related Links Inside CMS" section below.

Questions about the processing and shipping of CAP orders should be directed to the Approved CAP Vendor. The "Related Links Outside CMS" section has a direct link to the Approved CAP Vendor, BioScrip, Inc.

We strongly encourage Participating CAP Physicians to subscribe to the CMS-CAP-Physicians-L electronic mailing list in order to receive updates about the CAP. You may sign up for this list in the "Related Links Inside CMS" section below.

Once a physician has elected to participate in the CAP, they must obtain all HCPCS codes on the CAP drug list from the Approved CAP Vendor. Physicians can still continue to purchase and bill Medicare under the Average Sale Price (ASP) system for those drugs that are not provided by a physician's Approved CAP Vendor.

Please note that completed and signed physician election forms should be returned by mail to the local carrier that processes your Part B drug claims. Forms must be postmarked on or before February 15, 2008. DO NOT return forms to CMS offices.

New Changes to the CAP

The Centers for Medicare and Medicaid Services (CMS) published the 2008 Physician Fee Schedule (PFS) Final Rule in the Federal Register on November 27, 2007, which included regulations on the CAP that are effective January 1, 2008. Changes to the CAP due to new or updated regulations include:
- CAP drug administration claims may now be filed within 30 days of administering CAP drugs
- Participating CAP Physicians may now request to leave the CAP within the first 60 days of election if program participation results in any burden to a practice (ex: difficulty meeting CAP drug ordering or billing requirements)
- After 60 days, a Participating CAP Physician may request to leave the CAP if an unexpected change in circumstance results in CAP participation becoming a burden to a practice (ex: a change in patient population or practice personnel)

A copy of the 2008 PFS Final Rule can be obtained in the "Downloads" section of the "Regulations and Notices" page on this website.

Updates to the CAP Drug List

Effective January 1, 2008, Orthovisc (J7324), Tysabri (J2323), and Reclast (J3488) will be available through the CAP.  Additional information and the updated CAP drug list will be available on the website around the middle of the week of December 17, 2007. 

As a reminder, please note that the CAP Terms of Agreement state that elected CAP physicians must obtain all drugs on the CAP drug list from the Approved CAP Vendor.  Physicians can still continue to purchase and bill Medicare under the Average Sale Price (ASP) system for those drugs that are not provided by the Approved CAP Vendor.  BioScrip is the Approved CAP Vendor for 2008. 

Materials from the Ask the Contractor Teleconference (ACT) on October 3, 2007 at 2PM CST

On October 3, 2007, the CAP Designated Carrier, Noridian Administrative Services, hosted an Ask the Contractor Teleconference (ACT) about the CAP.  A .zip file containing the PowerPoint presentation, transcript, and audio recording of the event are now available in the "Downloads" section below.

Competitive Acquisition Program (CAP) for Medicare Part B Drugs and Biologicals: Physician Election Form Training November 6, 2007

The Centers for Medicare & Medicaid Services (CMS) and the Designated CAP Carrier, Noridian Administrative Services, LLC (NAS), are offering a web based workshop on November 6, 2007 at 12:00 pm (CST) for physicians electing into the 2008 Competitive Acquisition Program (CAP). During this workshop, NAS Staff will provide tips on filling out the Physician Election Form and will be available to answer questions during a Q & A session.

Registration information for this workshop can be found in the "Related Links Outside CMS"¨ section below via the link entitled "Register for CAP Physician Workshops."  Information on additional training for physicians who have elected into CAP is available through the website as well.

Ask the Contractor Teleconference on October 3, 2007 at 2 P.M. CST

The designated carrier for CAP, Noridian Administrative Services (NAS), will hold an Ask the Contractor Teleconference on October 3, 2007 at 2 p.m. CST.  Prospective CAP physicians will have an opportunity to learn more about CAP and how to elect into the program during the upcoming 2008 physician election period. Additionally, NAS staff will be available to answer questions.  To participate in the teleconference, please dial (877) 260-8899 on October 3, 2007.  No prior registration is required.

The 2008 Physician Election Period for the Medicare Part B Drug Competitive Acquisition Program (CAP) will begin on October 1, 2007 and will conclude on November 15, 2007.

2008 CAP Physician Election 

The 2008 CAP Physician Election Period will begin on October 1, 2007 and conclude on November 15, 2007. For physicians who elect to participate during this period, effective dates for the 2008 CAP will be from January 1, 2008 through December 31, 2008.

Physicians who are new to Medicare may elect into CAP during the fall election period or may submit an application during the first 90 days of their Medicare participation.  Current Medicare physicians may join CAP during this election period as well.  All current Participating CAP Physicians who are interested in continuing with the program for 2008 are required to renew their CAP election. 

A physician's or a physician group's decision to participate in the CAP is voluntary. Please note that when members of a group practice bill Medicare using the group's Physician Identification Number (PIN), or National Provider Identifier (NPI), they commit as a group practice to participate in the CAP.

The 2008 election period will use the same basic procedures and election agreement forms as previous election periods. Completed and signed forms must be returned by mail to the physician's local carrier (that is the carrier that processes the physician's Part B drug claims). Forms must be postmarked no later than November 15, 2007. Please do not mail in forms prior to October 1, 2007 or return completed forms to CMS.

The Physician Election Agreement form is available in the Downloads section below. Please note that the form may be filled out on-line and then printed. The CAP continues to serve one geographic area and has one approved vendor.

Additional details about CAP physician election are available in the 2008 CAP Physician Election Guide. The Guide is available in the Downloads section below.  Also, a one page document entitled "CAP Physician Election Tips" is available in the Downloads section below.

We encourage all prospective and existing Participating CAP Physicians to become familiar with the CAP-specific resources available to them. Please contact your local Medicare carrier for other basic information about the CAP.  Medicare local carrier contact information can be obtained through the CMS website.  Please see the "Related Links Inside CMS" section below.  Additionally, questions may be directed to the Designated CAP Carrier, Noridian Administrative Services (NAS) at (888) 671-0536. A link to NAS may be found in the "Related Links Outside CMS" section below.  Scroll down to the "Additional Resources for Physicians" section below for more information.

Questions about the processing and shipping of CAP orders should be directed to the Approved CAP Vendor. The "Related Links Outside CMS" section also has a direct link to the approved CAP vendor, BioScrip, Inc.

We strongly encourage participating CAP physicians to subscribe to the CMS-CAP-Physicians-L electronic mailing list in order to receive updates about the CAP. You may sign up for this list in the Related Links Inside CMS Section below.

CAP Physician Billing Tips

A brief guide on how to bill CAP claims is available in the download section below. This document discusses timeframes for claims submission, important information that must be included in CAP claims, and the proper use of CAP modifiers. (Updated 11/9/06).

Beneficiary Fact Sheet

Participating CAP Physicians are required to provide this fact sheet during a Medicare beneficiary's first visit to the physician's office subsequent to the start of a physician¡¦s participation in the CAP.  When distributing the CAP Beneficiary Fact Sheet, physicians may include additional information, such as contact information for the Approved CAP Vendor.  Participating CAP Physicians are only required to distribute the Beneficiary Fact Sheet once to each beneficiary but may provide the beneficiary with additional copies as necessary.

The Beneficiary Fact Sheet is available in both English and Spanish.  Use the following directions to order this document in English, publication #11148.  Up to 100 copies of the fact sheet may be ordered at a time.  If you have any problems ordering this document, send an email to mailpubs@cms.hhs.gov.

1.  Click on the CMS Publications Mailing List link below.  (See the "Related Links Inside CMS)

2.  Select the link "New user" Register here.

3.  Enter the password all lowercase: cms07

4.  Create a username and enter it twice.

5.  You will be prompted to change your password. The password can have numbers and/or letters. It must be at least five characters long.

6.  When filling in your contact information choose the following category from the drop down menu: Physicians.

7.  Proceed to fill in all forms required to register. If you do not add a shipping address after adding the contact information you will not see the publications. 

8.  Please note we do not ship publications to PO Boxes. Please refrain from including them in your address.

Both the English and Spanish versions are available on the CAP website  in the "Downloads" section below.

Key Points about the CAP

• Participation in the CAP is voluntary.
• Physicians who are new to Medicare will have 90 days to elect to participate in the CAP.
• For 2007 and subsequent years, the CAP program will run from January 1 to December 31 with a 45-day physician election period occurring in the fall.
•  Drug administration claims will continue to be paid by the physician's local carrier.
• All Local Coverage Determinations (LCDs) will continue to apply to CAP drug administration and CAP drug claims.
• The drug CAP is separate from the Medicare Prescription Drug Benefit (Part D) that went into effect January 1, 2006.
• The CAP for Part B Drugs and Biologicals is only for injectable and infused drugs currently billed under Part B that are administered in a physician's office, "incident to" a physician's service.
• There is only one competitive acquisition geographic area for 2008, which includes all 50 states and territories.
• There is one Approved CAP Vendor for 2008.
• Once a physician has elected to participate in CAP, they must obtain all drugs on the CAP drug list from their chosen drug vendor.
• Physicians still continue to purchase and bill Medicare under the Average Sale Price (ASP) system for those drugs that are not provided by the physician's Approved CAP Vendor. 
• Physicians will acquire CAP drugs from the Approved CAP Vendor. The Approved CAP Vendor will be responsible for submitting a claim for the drug to the Designated CAP Carrier, Noridian Administrative Services (NAS.) 
• The Approved CAP Vendor will be responsible for collecting the deductible and co-insurance from the beneficiary. This may not be collected until the Approved CAP Vendor has received Medicare payment for the drug (unless the CAP vendor has verified administration with the participating CAP).  Also, if the beneficiary has a supplemental insurance policy, the Approved CAP Vendor must wait to bill the beneficiary until payment from the supplementary insurer has been received.
• Completed and signed Physician Election Agreement forms should be returned by mail to your local carrier. Medicare carriers' mailing addresses are available in the Downloads section below; use the address listed under "Carrier." DO NOT MAIL COMPLETED FORMS TO CMS HEADQUARTERS IN BALTIMORE, MD.

Ask The Contractor Call:  2007 Additional Physician Election Period

On May 2, 2007 CMS and the CAP designated carrier, Noridian Administrative Services (NAS) hosted a teleconference. The teleconference provided physicians and their staff with an opportunity to learn more about the CAP and how to elect to participate in the CAP during the additional 2007 physician election period. A power point slide set, transcript and audio recording of the teleconference are available in the Downloads Section below.

Downloads
CAP Physician Billing Tips – Updated 9/2/08 [PDF, 260KB] October 2008 List of Drugs Supplied Under the CAP, Corresponding NDCs, and Vendor VIN [PDF, 122KB] July 2008 List of Drugs Supplied Under the CAP, Corresponding NDCs, and Vendor VIN [PDF, 120KB] April 2008 List of Drugs Supplied Under the CAP, Corresponding NDCs, and Vendor VIN [PDF, 121KB] January 2008 List of Drugs Supplied Under the CAP, Corresponding NDCs, and Vendor VIN [PDF, 166KB] October 2007 Ask the Contractor Teleconference [ZIP 20MB] CAP Physician Election Tips [PDF, 29KB] Physician Election Agreement Form for 2008 [PDF, 50KB] 2008 CAP Physician Election Guide [PDF, 78KB] - updated 12/28/07 Beneficiary Fact Sheet (English and Spanish Versions) [ZIP 117KB]
Related Links Inside CMS
Noridian Administrative Services - CAP for Part B Drugs and Biologicals MLN Matters Articles CMS Regulations and Notices CR 4064 - Competitive Acquisition Program (CAP) for Part B Drugs CR 4309 - Additional Requirements for the Competitive Acquisition Program (CAP) for Part B Drugs Medicare Carrier Addresses - Go to the Downloads section of the Medicare Enrollment page. Click on Medicare Fee-For-Service Contact Information. Use the information in the Carrier column. Sign up for the CMS-CAP-Physicians-L Electronic Mailing List  CMS Publications Mailing List
Related Links Outside CMS
Register for CAP Physician Workshops CAP Designated Carrier (Noridian Administrative Services) Approved CAP Vendor (BioScrip, Inc.)

Page Last Modified: 09/15/2008 12:50:43 PM
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