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Medicare Compliance & Reimbursement

HOSPITALS:

Don't Miss Out On Special OPPS Reimbursement

Published on Thu Apr 15, 2004

The scoop on the latest pass-through payments for new drugs and technologies.

A few more financial roadblocks have been lifted for hospitals.
 
The Centers for Medicare & Medicaid Services has unveiled special payments available under the outpatient prospective payment system for three additional drugs and four additional services.
 
Here's what Medicare outpatient coverage includes as of April 1, 2004.

 For injectible drugs:
 

  • Daptomycin (antibiotic for serious staph infections) at $0.31 per 1 mg,
     
  • Risperidone (antipsychotic) at $131.86 per 12.5 mg, and
     
  • Rasburicase, (treatment for high uric acid levels resulting from cancer treatments) at $105.54 per 0.5 mg.

     For technologies:
     

  • the insertion of a special device for measuring and monitoring acid levels associated with gastroesophageal reflux disease, paid at $450,
     
  • laser procedure that vaporizes the prostate and controls bleeding before and after the procedure, at $3,750, and
     
  • concurrent or immediate placement of a balloon catheter in the breast for interstitial radiation therapy following a partial mastectomy, at $2,750 (delayed placement, at $3,250).
     
     Reimbursement could still fluctuate once more cost data becomes available.
     To see the payment update, go to:     http://www.cms.hhs.gov/manuals/pm_trans/R132CP.pdf.

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