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A One-Stop-Shop for Medical and Radiation Oncology Billing News

Due to constant advancement of medical technology and healthcare regulations, oncology billing is a dynamic, fast-changing industry. RC Billing wants to keep clients on the leading edge of what's happening, so we maintain this area of the website as a "clearinghouse" for information about oncology news, local coverage determination, CPT codes, IMRT billing and coding and general oncology billing services. Whether it's a legal change that could affect our industry or just an opportunity to pass along the latest news, you'll find it here.

Medical Oncology News

April 2017 Medical Oncology News (View More News and Articles)

MedPAC Recommends New Part B Drug Pricing System

In early March 2017 the Medicare Payment Advisory Committee (MedPAC) was presented with recommendations by the chairman for reforming the Part B drug payment program. On April 6, 2017, MedPAC voted unanimously to recommend a competitive pricing program and other reimbursement changes for the Medicare Part B drug program.

The new pricing system would include a voluntary Drug Value Program (DVP). The DVP would include a small number of vendors who would negotiate prices paid for the drugs; however, these vendors would not be the ones shipping the drugs. The providers who volunteer in the DVP would purchase the drugs at the vendor-negotiated rate and Medicare would then pay the providers the rate plus an administration fee. The administration fee would be based on either the Medicare Physician Fee Schedule (MPFS) or Hospital Outpatient Prospective Payment System (HOPPS) rate. Additionally, participating providers would also be able to share in any cost savings as part of the DVP.

Additional changes to the Part B drug program by MedPAC include the following: 

  • Improving reporting of the average sales price (ASP) data. All manufacturers of drugs covered under Part B would be required to report data, not just those who have arrangements with Medicaid, and penalties would increase for those not reporting. 
  • Payments modified for drugs paid at wholesale acquisition cost (WAC) to WAC +3%; a reduction from the current rate of WAC +6%. 
  • Limit payment rate increases for drugs based on ASP. Currently there is no limit on how much the payments can increase. Manufacturers would pay a rebate if their products’ ASP exceeded a particular inflation benchmark, such as the consumer price index. 
  • Implement consolidated billing codes for biosimilar drugs. Reference biologics and their biosimilars would be paid under a single code; this would match the current process for brand-name drugs and their generic counterparts. Additionally, the Health and Human Services Secretary might also consider using a consolidated billing code for groups of products with similar health effects.

In an effort to make the DVP more attractive for providers to participate in, the ASP add-on percentage would be cut. If these changes by MedPAC were implemented, the Part B drug program could result in a projected decrease in spending of $250-$750 million in the first year and $1 billion to $5 billion over the next 5 years.  

MedPAC also attended a presentation on what a Medicare premium support program would include in the event Congress and the Trump administration instituted such a program. A Medicare premium support program would provide Medicare beneficiaries with a set amount of money from the federal government to purchase one of several health insurance plans available. Concerns were discussed if such a program was instituted and what it could mean for beneficiaries of various incomes or how access to information by beneficiaries could impact their decisions for healthcare. MedPAC indicated they were not endorsing a premium support program, but felt it was their responsibility to discuss and provide information and advice concerning ideas others have mentioned to revamp the Part B drug program.  

You can stay current with oncology coding and reimbursement news through Revenue Cycle Inc.’s Client Resource Center (CRC) which offers easily accessible answers around the clock, along with a library of resources and articles. To find out about an annual subscription and all of our consulting services, please call us at 512-583-2000 or visit our contact page.


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