HCPro, JustCoding Outpatient - 2016 Issue 14 (April)
CMS proposes Part B drug payment test with flat-fee add-on, value-based purchasing tools
April 12th, 2016
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Article Overview
This article covers a CMS Innovation Center proposal affecting Medicare Part B drug reimbursement for physicians, hospitals, and other suppliers. It outlines the proposed two-phase test, the general categories of payment and value-based purchasing tools being considered, the national scope of the model, and the comment process for stakeholders who may be affected. The piece is relevant to providers, compliance teams, pharmacy leadership, and coding/reimbursement professionals tracking Medicare drug payment policy.
Why This Topic Matters
The proposal could affect how Part B drugs are paid across a broad provider population and may influence purchasing, prescribing, and operational planning. Understanding the scope and timing of the model helps organizations evaluate potential financial and workflow impacts and prepare comments on the rule.
Article Sections
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Phase one
Describes the first stage of the proposed payment test, including the general structure of the comparison groups, the types of drugs considered, and broad exclusions and exceptions.
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Phase two
Summarizes the second stage of the proposal and the categories of value-based purchasing approaches CMS says it may evaluate in a limited way for selected drugs.
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National scope
Explains the expected geographic reach of the model, the grouping framework CMS proposes, and the general comment and implementation timeline.
What You Will Learn
- How CMS is structuring a proposed two-phase Medicare Part B drug payment test
- Which broad categories of drugs and providers may be affected
- What types of value-based purchasing concepts CMS is considering
- How the proposed model would be organized geographically and operationally
- What stakeholders are being asked to comment on before implementation
Who Should Read This
- Physician practices
- Hospitals and outpatient departments
- Hospital pharmacy departments
- Revenue cycle and reimbursement professionals
- Compliance and regulatory staff
- Healthcare policy analysts
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