Inherent reasonableness rule could result in lower drug payments

Article Overview

This article explains a CMS interim final rule that allows administrative adjustments to selected Medicare Part B payment categories and discusses the policy’s expected impact on providers, drug manufacturers, and related services. It is relevant to medical coders, billing staff, compliance teams, and specialty practices that bill Medicare Part B for drugs, durable medical equipment, and physician office lab services. The piece also summarizes the public comment process, CMS’s stated rationale, and concerns raised by stakeholders about reimbursement policy and practice economics.