tci Medicare Compliance & Reimbursement - 2004 Issue 38

Drug Payments: 2005 Drug Rates Will Be A Surprise - Even To CMS

Nobody will know in advance the numbers on which Medicare will base drug payments in 2005, not even the Centers for Medicare & Medicaid Services.That's because CMS will base the 2005 drug payments on 106 percent of the "average sales price" for the third quarter of 2004. CMS won't have that data until early December, and it'll be a scramble to translate the data into HCPCS codes in time for Jan. 1, 2005.When the final physician fee schedule rule comes out in November, it will be based on second quarter 2004 data, which CMS just received. CMS...

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