tci Medicare Compliance & Reimbursement - 2004 Issue 21
Dialysis: OIG Says Dialysis Drug Payments Exceed Costs
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Article Overview
This article covers an HHS Office of Inspector General analysis of Medicare dialysis drug payments versus acquisition costs, with attention to end-stage renal disease drugs and the planned move from average wholesale price-based reimbursement to average sales price-based payment. It is relevant to coding, compliance, and reimbursement professionals who follow Medicare payment policy for dialysis services and related pharmaceuticals. The discussion also places the findings in the context of the Medicare Modernization Act and CMS payment policy changes.
Why This Topic Matters
The topic matters because it highlights Medicare reimbursement policy for dialysis drugs, an area where payment methodology can materially affect provider margins and compliance oversight. It also shows how HHS OIG findings can influence CMS payment updates and broader policy changes affecting dialysis facilities.
What You Will Learn
- How the HHS Office of Inspector General evaluated dialysis drug acquisition costs relative to Medicare reimbursement
- Why dialysis drug payment methodology was under review in the context of Medicare policy
- How the Medicare Modernization Act influenced the planned transition in reimbursement approach
- What the report suggests about differences between large dialysis providers and other facilities
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Revenue cycle managers
- Dialysis providers
- Healthcare reimbursement analysts
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