medicare part b billing pharmacy

Physicians To See Increase In Medicare Part B Payment Despite 340B Cuts

The recent research reveals that about 85% of the hospitals in USA will witnessing a raise in their Medicare part B because of the recent changes in the Medicare outpatient payment charges hence; medical coding too get revised.

The Medicare payment charges came into effect on January 1, 2018 which had revealed a major reimbursement payment cut under 340 B drupartg program. This offers discounted outpatient drugs to health care facilities which are coming under low income patient populations. However; it is believed that despite of the 340B cuts; hospitals and physicians are likely to see increase in their Medicare Part B program. It is revealed that physicians will see on an average about 1.5% increase in their total Part B payments. Especially the rural hospitals will be benefitting under this facility witnessing a net increase of 2.7% and urban hospitals will see 1.4%.

However; the 340B program is proposed to allow hospitals use savings from drug discounts to improve care for underserved patients, a recent study found that the discounts only strengthen the incentives for hospitals to supply drugs to patients who have generous insurance coverage.

The 340B Drug Pricing Program permits hospitals that treat greater proportions of low-income patients to acquire outpatient drugs from manufacturers at a discounted price. The program aims to “stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.

Before 2018 OPPS final rule, Medicare used to reimbursed 340B hospitals the average sales price plus 6 percent. CMS reduced the 340B drug payments to average sales price minus 23 percent for separately payable, non-pass through drugs and biological in the November 2017 OPPS final rule.

This new payment policy will reduce 340B hospital payments by $1.6 billion. But CMS plans to shift the savings to other parts of the OPPS.

However, healthcare stakeholders argued that 340 drug payment reductions would prevent hospitals from serving vulnerable patients. An analysis from 340B Health found that all medical billing and hospitals surveyed agreed that the payment cuts would impact their ability to deliver healthcare services to low-income and rural patients.

But the new analysis indicated that hospitals and physicians are positioned to benefit from the OPPS changes, including the 340B payment cuts. And rural hospitals will particularly gain revenue.

Additionally, the study responded to the concerns that the 340B payment program incentivized contributing hospitals to leverage drug discounts to generate a profit, rather than improving care for vulnerable populations.

Having an outsourcing medical billing and coding company for 340B compliance services can stretch across all aspects which include:

The medical billing service provider’s consulting is rooted in the 340B regulations. It is informed by HRSA/OPA guidance and their vast 340B experience. Their direct HRSA experience, on-site audit time, and longevity working with the program are unrivalled in the industry.

They continually apprise you of regulatory developments that could impact your program. They help you to lay out responsive courses of action to ensure your continuing compliance with regulations while minimizing additional administrative costs.

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