decisionhealth Newsletters, Part B News - 2007 Issue 7 (July)
Drug price changes: ASP calculation tops list of proposed 2008 drug changes
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Article Overview
This article explains proposed Medicare physician payment policy changes affecting drug pricing and the Competitive Acquisition Program for 2008. It is relevant to medical billing, pharmacy reimbursement, oncology and other practices that administer Medicare-paid drugs, as well as coding and compliance teams tracking CMS proposals and operational impacts. The discussion covers ASP calculation methodology, bundled-drug reporting, CAP vendor payment and review processes, patient copayment issues, and opt-out procedures under proposed CMS rules.
Why This Topic Matters
These proposals could affect how Medicare drug prices are calculated, how vendors and practices interact under CAP, and how offices prepare for reporting, payment, and audit-related workflow changes.
Article Sections
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ASP bundled discount proposal
Overview of CMS’s proposed changes to how bundled discounts are reported for Medicare drug pricing. The section explains the general policy direction and its potential effect on average sales price calculations.
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CAP changes
Summary of proposed revisions to the Competitive Acquisition Program. The section covers vendor payment processing, post-payment review, practice participation requirements, appeal processes, and opt-out procedures.
What You Will Learn
- How the article frames proposed Medicare drug pricing updates for 2008
- What categories of ASP reporting changes CMS is considering
- How the article describes proposed operational changes to the Competitive Acquisition Program
- What kinds of practice and vendor workflow issues the proposed CAP revisions address
Who Should Read This
- Medical billers
- Coders
- Compliance staff
- Practice managers
- Physician office administrators
- Pharmacy reimbursement personnel
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