Medicare Compliance & Reimbursement
CMS Mulling Pharmacist Payment Adjustments To Shore Up Drug Benefit
News reports have highlighted some pharmacists' financial problems stemming from the Medicare prescription drug benefit, purportedly relating to health plans' slower reimbursement for dual eligibles' claims. (See related story in this issue.) Now the Centers for Medicare & Medicaid Services is considering increasing reimbursements for pharmacists who convince customers to switch from brand-name to generic medications, according to CMS Administrator Mark McClellan.
Another proposal CMS is deliberating is to make substantial billing and coding changes that would reduce costs for filing medical claims, says CMS spokesman Peter Ashkenaz. The agency will hold a public meeting April 24 to hear comments about the proposed payment incentives for pharmacists who prescribe generics.
Although CMS is undertaking measures to help struggling pharmacists--especially independent community pharmacies, which often have only limited reserves to draw on in case of temporary shortfalls--agency representatives also doubt that the drug benefit is the sole cause of the problem. "I think what we're seeing is a change in the business model that continues a trend that has occurred over the past 15 years," McClellan ventures.
In related news, consolidation in the insurance industry is likely to pare down the number of private plans offering prescription drug coverage under Medicare, McClellan speculates. "I think you'll see significantly fewer choices available next year, but they will be choices dictated by the market, by what consumers want," he says. In addition, CMS has been speaking to insurers about reducing the number of stand-alone drug plan offerings from three to two.
Medicare Compliance & Reimbursement
- HEALTH PLANS:
Streamline Part D Turnaround Time To Head Off Potential Regulatory Changes
Most EHR systems fall to track revisions' sources, study shows.
Lagging Medicare Part D drug reimbursements [...] - PART D:
CMS Mulling Pharmacist Payment Adjustments To Shore Up Drug Benefit
Industry consolidation may narrow Medicare drug benefit to fewer plans next year.
News reports have highlighted [...] - P4P:
Home Care Not An Exception For P4P Shift
CMS plans to launch a P4P demo for the home care industry--soon.
Providers can't just ignore [...] - CONSULTATIONS:
OIG Initiates A New Crackdown On Consult Billing
Three out of four consults billed incorrectly, OIG says.
Consults look like a juicy target to [...] - COMPETITIVE BIDDING:
Bidding Rule Coming Out 'Very Soon,' CMS Promises
Bid items may vary for different bid areas.
Durable medical equipment suppliers soon will see the [...] - THERAPY:
HHAs Should Hold Off On Expedited Determination Notices For Part B Therapy
They can't reach for HHABNs either.
Home health providers can avoid unnecessary extra work if they [...] - NURSING HOMES:
RUG Software Could Be Costing LTC Facilities Thousands
Software snags may drag down nursing homes' per diems.
Without naming names, the Centers for Medicare [...] - BUDGET:
Senate, House Budget Committees Pass Budget Resolutions
Republican struggle could mean bad news for Medicare.
On March 16, the Senate passed the budget [...] - INDUSTRY NOTES:
Feds May Look Into Podiatrists' Nail Debridement, Chiropractors' Services
Plus: OIG offers opinion on physician's office housing a DME supplier.
Medicare could save $285 million [...]
