Reimbursement: GAO TARGETS NEW AWP PAYMENT HEMORRHAGE

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This short reimbursement news item discusses a GAO report on Medicare payment for blood clotting factor and the broader issue of drug pricing based on average wholesale price. It is relevant to readers tracking Medicare payment policy, biologicals, hemophilia treatment services, and the financial impact on providers. The article also notes the GAO’s recommendation that CMS consider separate payment for delivery-related costs if reimbursement is reduced.

Why This Topic Matters

It helps billing, reimbursement, and compliance professionals understand a federal review of Medicare payment methodology for a high-cost biological and the possible implications for provider costs and payment policy.

What You Will Learn

  • Why the article discusses Medicare reimbursement concerns for a blood clotting factor biological
  • How the GAO report frames payment methodology and provider acquisition cost issues
  • What general payment-policy concern is raised for providers who deliver clotting factor to Medicare beneficiaries
  • How the report relates to broader discussions about drug and biological payment policy

Who Should Read This

  • Medical coders
  • Reimbursement specialists
  • Billing staff
  • Compliance teams
  • Hemophilia treatment center administrators
  • Home infusion or home care billing professionals

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