decisionhealth Newsletters, Part B News - 2017 Issue 10 (October)
Proposal to include Part B drug charges under MIPS scoring elicits concerns
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Article Overview
This article explains a proposed Medicare payment policy under the Quality Payment Program that could alter how Part B drug charges are treated in MIPS scoring. It is aimed at providers, specialty practices, and billing professionals who want to understand the potential revenue impact, stakeholder concerns, and the broader implications for practices that administer high-cost drugs. The discussion also references CMS, specialty society comments, and analysis of possible payment adjustment effects over future performance years.
Why This Topic Matters
The proposal could significantly affect reimbursement patterns for practices that purchase and administer expensive Part B drugs, especially in specialties with high drug spend. Understanding the policy context helps readers assess potential exposure, advocacy positions, and operational risk before the final rule is issued.
Article Sections
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Overview of the proposed QPP change
Introduces the pending Quality Payment Program rule and the proposed treatment of Part B items and services within MIPS. It sets up why the issue matters for practices that bill Medicare for drug-related services.
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Stakeholder concerns and practice impact
Summarizes reactions from consultants and specialty leaders about potential effects on practice revenue and cash flow. It highlights concerns for smaller and rural practices as well as those with high drug spending.
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Estimated payment adjustment effects
Describes projections and commentary on how MIPS-related payment adjustments may vary over performance years. It contrasts different estimates and discusses the magnitude of potential exposure for participating practices.
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Specialty-specific implications and advocacy
Reviews which specialties may be more affected and discusses concerns raised by professional organizations. It also notes calls for CMS to reconsider the proposal and mentions the limited alternatives available under other payment models.
What You Will Learn
- What the proposed Quality Payment Program change is generally about
- Why Part B drug billing has drawn concern in the MIPS context
- Which types of practices and specialties may be most affected
- How professional organizations are responding to the proposal
- What broader payment-model issues are connected to the discussion
Who Should Read This
- Physicians and specialty practices
- Medical billing and coding professionals
- Practice administrators
- Health policy and reimbursement analysts
- Oncology, rheumatology, and ophthalmology stakeholders
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