Oplinc Best Practices Review, Volume 12, Issue 1
Health Care Fraud and Abuse Control Programs 1, 2, 3
Health Care Fraud and Abuse Control Programs 1, 2, 3
Obama Administration Halts Part B Drug Model JW Modifier – No Mandatory
CMS Releases Medicare 2017 Final Rules
Medicare Policy Clarified for Prolonged Drug and Biological Infusions Started Incident to a Physician’s Service Using an External Pump
On October 30, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a final rule updating payment rates and quality provisions for services provided under the Medicare Physician Fee Schedule (PFS). The 2016 PFS final rule is the first PFS final rule since the repeal of the Sustainable Growth Rate (SGR) formula, and as […]
New Proposed Change to ASP Pricing for Part B Drugs On February 5th, the Centers for Medicare & Medicaid Services (CMS) posted and then removed a transmittal to Medicare contractors that outlined a new payment model to be tested for Part B drugs. Transmittal 137, Change Request 9501 was to have an effective date of […]
Congress Comes together to replace the SGR Formula The Sustainable Growth Rate (SGR) formula was implemented to limit the growth in Medicare expenditures on physician services. Under the SGR, physician payments were determined through a formula that linked Medicare spending to economic growth. For the first few years the SGR formula did work as intended. […]
Orphan drugs are pharmaceutical agents developed specifically to treat a rare medical condition. In the United States, an orphan drug is defined as a drug that treats a disease that affects less than 200,000 individuals, or less than 5 per 10,000 people in a community. Orphan drug status is becoming more common due to research […]