RAC Audit Alert: Erythropoiesis Stimulating Agents for Cancer Patients
On December 10, 2019, the Centers for Medicare and Medicaid Services (CMS) approved a RAC audit for “Erythropoiesis Stimulating Agents for Cancer Patients: Medical Necessity and Documentation Requirements” which will apply to all A/B MACs. Medical records will be reviewed to determine if the use of ESA in cancer and related neoplastic conditions meets Medicare coverage criteria. ESA treatment for the anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma, and lymphocytic leukemia is only reasonable and necessary under specified conditions which are outlined in the National Coverage Determination Manual, Chapter 1, Section 110.21: Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions).
Questions about the audit can be sent to ASCO staff at email@example.com.