Medicare Compliance & Reimbursement

CMS may reimburse for more Part Bs.

Good news for hospitals that administer biologicals and radiopharmaceuticals in their outpatient departments: the Centers for Medicare and Medicaid Services wants to pay hospitals more for most Part B drugs.

The best news could be for acute care hospitals, which  could receive a 3.2 percent inflation adjustment to their payment rates under the outpatient prospective payment system in 2006, CMS announced July 18. Sole Community Hospitals Looking At Increase CMS' proposed rule contains policy changes and updated payment rates, including:

Coinsurance rates will decrease gradually to 20 percent of the hospital's total payment for 12 additional medical and surgical ambulatory payment classifications.

Sole community hospitals in rural areas may see an additional 6.6 percent payment adjustment.

Medicare could pay 106 percent of the drug manufacturer's average sales price for Part B drugs administered in hospital outpatient departments.

CMS proposes to pay an additional 2 percent over the Part B drug payment to cover pharmacy costs until 2008. MedPAC Recommendation Impacts CMS
 
CMS also proposes to implement the Medicare Payment Advisory Commission's recommendations to Congress regarding payment changes for outpatient diagnostic imaging procedures.

When you perform two or more procedures in the same CMS-identified imaging procedure "family," Medicare will pay for the first procedure in full and 50 percent of the second and subsequent procedures, according to CMS.

The proposed rule appeared in the July 25 Federal Register and providers can submit their comments until Sept. 16, 2005.

Read it online: To read CMS' press release, go to http://www.cms.hhs.gov/media/press/release.asp?Counter=1506.