Some practice expense calculations could be flawed, GAO says

Why This Topic Matters

Practice expense methodology affects Medicare payment levels across specialties, so changes in how CMS calculates these values can shift reimbursement patterns for physician and non-physician services. The article is relevant to specialty practices, coding and reimbursement professionals, and anyone tracking CMS policy changes or GAO oversight of Medicare payment systems.

Article Sections

1. CMS practice expense methodology and GAO concerns

   Introduces the Medicare practice expense calculation issue, including CMS’s interim approach and the GAO’s concerns about compliance with congressional direction.

2. Transition to resource-based calculations

   Summarizes the broader shift in Medicare payment methodology and notes that different specialties were affected differently by the transition.

3. Impact on oncology and specialty payment levels

   Discusses the complaints that prompted the GAO review and the article’s discussion of how practice expense changes may affect payments across specialties.

4. GAO recommendations and CMS response

   Outlines the GAO’s proposed areas for methodology improvement and CMS’s general response to the report.