Jul 23, 2018 | 340B, Hospitals
There have been several recent noteworthy policy and legislative developments related to the 340B drug pricing program. The program, which requires drug manufacturers to sell outpatient drugs at a discount to covered entities, has been under pressure from policymakers as well as lawmakers under the Trump Administration. This brief discusses recent developments related to 340B reform, including a recent GAO report, comments made by HHS Secretary Azar, and recently proposed legislation. Read more here
Jul 18, 2018 | DMEPOS, MedPAC
The Medicare Payment Advisory Commission (MedPAC) recently released a report that compared Medicare rates for durable medical equipment (DME) not subject to competitive bidding to rates paid by commercial plans. MedPAC found that Medicare was paying as much as 20% to 60% higher for some products, such as orthotics, ventilators, and diabetic supplies. MedPAC used a leading national commercial database, Truven MarketScan data for its analysis, using 2015 data. BRG also utilizes Truven’s MarketScan data to analyze commercial rates at the local (Metropolitan Statistical Area), state, and...
Jul 18, 2018 | Physician Fee Schedule
In the past, CMS focused primarily on oversight of individual providers’ coding practices through mechanisms such as the CBRs, audits and compliance enforcement actions. But in the newly released CY2019 Physician Fee Schedule proposed rule, CMS proposes to address these issues through two general changes to outpatient and office E/M codes. Click to read more
Jul 17, 2018 | Physician Fee Schedule
This brief provides an overview of the 2019 proposed update to the physician fee schedule. Click to read more
Jul 13, 2018 | Managed Care Friday
1. 6157: The name of a Senate bill in Washington state that forced Regence BCBS to do away with a policy requiring pre-approval for PT, chiropractic, massage, OT and speech therapy for the first 6 visits after an initial evaluation. A source with Evicore, which handles these requests for the insurer, told us it will identify patients who won’t need the authorization in this state. Pre-approval is required for visits after 7 and, due to the policy, an Evicore therapy evaluator said, ‘this sort of makes it harder to get approval for more than 3-5’ unless it’s a youth injury situation or a...
