decisionhealth Newsletters, Part B News - 2006 Issue 4 (April)
Some commonly billed drugs see pay boosts
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Article Overview
This article summarizes a CMS quarterly update to the Part B average sales price list and highlights how payment changes affected frequently billed drugs and vaccines. It is relevant to practices, billers, and coders who track drug reimbursement trends, ASP updates, and retroactive payment changes. The article also discusses broader market movement in the update, including major upward and downward price changes and a short note on payer handling for certain vaccine billing issues.
Why This Topic Matters
Practices that bill Part B drugs need to monitor ASP updates because reimbursement can change quarter to quarter, affecting claim amounts, adjustments, and office revenue. The article helps readers identify which commonly billed drugs saw significant movement and whether any retroactive payment corrections may apply.
Article Sections
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CMS quarterly ASP update and payment changes
Overview of the quarterly update to Medicare Part B drug payment amounts and the general pattern of increases, decreases, and unchanged items.
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Vaccine payment notes and preservative-free coverage discussion
Discussion of payment handling for selected vaccine-related HCPCS codes and a brief explanation of how CMS addressed a billing concern.
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High-volume drugs with significant price increases
A table of frequently billed drugs whose payment amounts rose by notable percentages during the quarter.
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High-volume drugs with significant price decreases
A table of frequently billed drugs whose payment amounts declined by notable percentages during the quarter.
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Retroactive January changes
Summary of first-quarter payment revisions that were made retroactive and a note about possible claim adjustment processing.
What You Will Learn
- How CMS quarterly ASP updates can affect Part B drug reimbursement
- Which broad categories of commonly billed drugs experienced notable payment movement
- How retroactive payment updates may affect previously submitted claims
- How the article organizes high-volume increases and decreases in payment amounts
Who Should Read This
- Medical coders
- Billers and reimbursement specialists
- Practice managers
- Outpatient and physician office staff
Codes Discussed
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