99% of ‘J' code payments based on 2nd quarter ASP data released

Why This Topic Matters

Changes to drug payment methodology can affect reimbursement, practice revenue planning, and Medicare billing operations across multiple specialties. Readers need to understand the scope of CMS guidance and the broader payment framework before the final payment data is implemented.

Article Sections

1. ASP-based Part B drug payment outlook

   Overview of the newly released payment data and the timing of CMS’s final payment information. The section also discusses anticipated impacts on different specialties and overall reimbursement trends.

2. CMS guidance and payment timing

   Discussion of CMS instructions to Part B contractors and when payment information is expected to become available. The section references the Medicare Claims Processing Manual and related implementation timing.

3. Alternative payment methods and exceptions

   Summary of the general circumstances CMS cites for paying drugs under methods other than the primary ASP-based approach. It also notes other federal program and agency-based payment references.

4. Specialty and policy concerns

   Comments from a specialty physician and concerns about the transition to the new payment system. The section also mentions a federal report due the following year.