Outpatient Facility Coding Alert - 2004 Issue 43
Meetings: 'Least Costly Alternative' Could Cost You A Bundle Next Year
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Article Overview
This article covers two Medicare payment-policy issues raised in advisory meetings: carrier use of the least costly alternative policy for drugs and the financial impact of pool leakage on cardiothoracic surgeons. It is relevant to physicians, surgical groups, practice managers, and coding/reimbursement professionals tracking Medicare payment methodology and advisory board recommendations.
Why This Topic Matters
The piece highlights policy changes and carrier practices that can materially affect provider reimbursement, practice expenses, and advocacy efforts within Medicare payment systems.
Article Sections
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Drug reimbursement and the least costly alternative policy
Discussion of carrier practices affecting payment for certain drug therapies and the concerns raised at a physician advisory meeting about Medicare reimbursement methodology.
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Pool leakage and cardiothoracic surgery costs
Coverage of a cardiothoracic surgery payment issue involving clinical staff expenses brought to a Medicare advisory commission and the potential responses suggested by providers.
What You Will Learn
- How a Medicare payment policy can affect reimbursement for drug therapies
- Why providers raised concerns about carrier application of drug payment rules
- What the term pool leakage refers to in the context of cardiothoracic surgery costs
- Which advisory bodies discussed these payment issues and potential next steps
Who Should Read This
- Physicians
- Surgeons
- Practice administrators
- Medical coders
- Reimbursement specialists
- Healthcare finance professionals
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