decisionhealth Newsletters, Part B News - 2012 Issue 7 (July)
Q3 drug prices boast equal cuts and raises, average slight increases
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Article Overview
This article reviews CMS’s third-quarter 2012 average sales price update for Medicare drug billing. It summarizes general pricing movement, highlights the mix of increases and decreases across frequently billed drug codes, and notes additions and deletions in the HCPCS drug code set. It also touches on CMS guidance about reimbursement for codes not included in the quarterly pricing files and a delay in the planned switch to AMP-based pricing. The article is relevant to coders, billers, and reimbursement professionals who track drug code updates and quarterly payment changes.
Why This Topic Matters
Quarterly ASP updates can affect reimbursement for commonly billed drugs and alert practices to code set changes that may influence claim processing and payment expectations.
Article Sections
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Drug pricing
General quarterly pricing trends for the Medicare drug file, including broad movement across commonly billed drugs and CMS’s overall update for the period.
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Watch for new, deleted drug codes
A summary of code set maintenance for the quarter, including newly added and deleted HCPCS drug identifiers and related CMS billing notes.
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CMS delays AMP-based substitution policy
Background on CMS’s continued use of ASP pricing and the delayed transition to an AMP-based approach referenced in the quarterly update.
What You Will Learn
- How CMS described the quarterly direction of drug pricing updates
- Which kinds of HCPCS drug code changes were reported for the quarter
- What CMS said about non-filed HCPCS pricing and contractor-based payment handling
- Why the planned pricing methodology change was delayed
Who Should Read This
- Medical coders
- Billing staff
- Reimbursement specialists
- Practice managers
- Medicare claims teams
Codes Discussed
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