tci Medicare Compliance & Reimbursement - 2016 Issue 7

Industry Note: CMS Creates Proposal for New Medication Injection Payments

In its ongoing effort to pay physicians based on quality of care and to cut costs, CMS has released a proposal to overhaul the way physicians are paid to administer drugs. The agency has offered six proposed approaches to pay for Part B drugs, including one that would reimburse doctors for the average sales price of a drug, plus a 2.5 percent add-on, as well as a flat fee payment of $16.80 per drug per day. Meanwhile, a “control group” would continue to be paid the current way, which is to collect the drug’s average...

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