drugsThe Trump administration is being warned by experts in the healthcare industry that its proposal to move over some drugs covered by Medicare Part B to Part D would negatively impact care quality and provider reimbursement.

In its efforts to lower the cost of drugs, policymakers made a promise to take a closer look at which Medicare Part B drugs could be negotiated for a lower price by Part D plans. Part B drugs largely consist of medications administered by physicians. This transfer is intended to cut down on incentives to deliver the Part B drugs in the priciest setting.

The proposed move could affect providers in regards to revenue and the role they play in physician-administered drug purchasing, storing, and billing. It may also result in unintentional patient access barriers resulting from differences in payment, cost-sharing, reimbursement, and settings of care in Part B and Part D.

With Medicare Part B, providers administer the drug and a claim is then submitted to the Medicare Administrative Contractor for reimbursement that covers both the medication and its administration. Prescription Drug Plans in the Part D program, on the other hand, typically contract with pharmacies to provide the medications directly to a consumer. These differences in how Medicare pays for prescription drugs could create problems for providers administering Part D-covered drugs.

To read more, please visit https://revcycleintelligence.com/news/how-part-b-drug-changes-could-impact-provider-reimbursement.

This update is by Medical Accounts Systems, a full-service healthcare revenue cycle management company providing a number of services including insurance follow up and managed care disputes, physician reimbursement, extended business office services, and more. For additional information on our services or for any questions you may have on topics such as medical debt collection, please call 877-759-6315.