Specialists who claimed millions in drug payments could face fluctuating rates

Why This Topic Matters

High-volume Part B drug billing can materially affect how practices are measured under MIPS, creating the possibility of larger payment adjustments in future years. The article helps specialty practices understand why drug-payment patterns may influence reimbursement exposure and why the issue is important to monitor.

Article Sections

1. Medicare drug billing and MIPS exposure

   Introduces the connection between Medicare Part B drug billing and potential future payment variability under MIPS. Summarizes why large drug-payment totals may be relevant to practices and specialties.

2. Highest-reported drug codes in 2015

   Discusses the drug-code billing patterns that appeared most often in Medicare claims data for 2015. Provides context on the overall scale of payments associated with the most frequently reported codes.

3. Specialty payment patterns for high-volume drug codes

   Reviews how payment amounts for selected drug codes were concentrated among specific physician specialties. Highlights the specialties most associated with the largest payment totals in the claims data.

4. Policy timing and MIPS rule review

   Notes the status of the MIPS final rule and the policy question it is expected to address. Places the billing data in the context of pending federal review and future reimbursement implications.