Medicare Part B

Medicare Part B Spending on Laboratory Tests Totaled $9.3B in 2021

December 27, 2022 - Medicare Part B spending on laboratory tests increased by 17 percent between 2020 and 2021, resulting from high volumes of COVID-19 tests, genetic tests, and chemistry tests, a report from the Office of Inspector General (OIG) found. The Protecting Access to Medicare Act of 2014 (PAMA) aligned Medicare payment rates for lab tests with private payer...

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CMS Will Apply Higher 340B Hospital Reimbursement Rate After Court Ruling

by Jacqueline LaPointe

Following a court order, CMS is revising its methodology for paying 340B hospitals for outpatient drugs and reprocessing claims paid on or before the Sept. 28th ruling. CMS will reimburse hospitals...

COVID-19 Tests Spike Growth in Medicare Spending

by Sarai Rodriguez

COVID-19 tests spiked growth in Medicare spending in 2020. Meanwhile, spending for non-COVID-19 lab tests experienced a decline, according to a report from the HHS Office of the Inspector...

CMS Defines “Reasonable and Necessary” Medicare Coverage

by Jacqueline LaPointe

CMS has codified how it defines “reasonable and necessary” coverage for items and services that may be covered under Medicare Parts A and B in a new final rule. The rule finalized on Jan....

CMS Ends Advance Payments for Physicians, Other Part B Providers

by Jacqueline LaPointe

CMS recently announced that it has suspended the Advance Payment Program for physicians, non-physician practitioners, and other qualifying Medicare Part B suppliers during the COVID-19 pandemic. For...

Medicare Payment Doubles for High-Production Coronavirus Lab Tests

by Jacqueline LaPointe

CMS is nearly doubling Medicare payment for high-production coronavirus lab tests in efforts to boost COVID-19 testing capacity and monitoring in nursing home communities and other coronavirus...

Hospitals Retain 91% of Profit from Physician-Administered Drugs

by Jacqueline LaPointe

Physician practices and hospital outpatient clinics treat a similar number of commercially insured patients needing physician-administered drugs, but hospitals receive a larger share of the gross...

OIG Suggests Lowering Medicare Reimbursement for More Part B Drugs

by Jacqueline LaPointe

CMS could have saved an additional $2.9 million in 2017 if the agency lowered Medicare reimbursement for more Part B drugs through price substitution, the HHS Office of the Inspector General (OIG)...

Potential Medicare Reimbursement Demo to Lower Part B Drug Prices

by Jacqueline LaPointe

In an effort to control prescription drug prices, HHS is proposing a mandatory demonstration that would test a new Medicare reimbursement model for certain physician-administered drugs payable under...

How Part B Drug Changes Could Impact Provider Reimbursement

by Jacqueline LaPointe

Healthcare industry experts are warning the Trump Administration that its proposal to transfer some drugs covered by Medicare Part B to Part D would have a negative impact on provider reimbursement and...

85% of Hospitals to See Part B Increase Despite 340B Payment Cuts

by Jacqueline LaPointe

EDITOR'S NOTE: This article has been updated with a statement from the American Hospital Association. Approximately 85 percent of hospitals will receive a net increase in their total Medicare Part...

AMGA: Align Medicare Advantage, APMs to Promote Value-Based Care

by Jacqueline LaPointe

If CMS moves forward with relaxing Medicare Advantage benefit requirements, then the federal agency should offer the same flexibilities to providers and beneficiaries in Medicare Part B alternative...

Orgs Argue MIPS Adjustments for Drug Payments Harm Patient Access

by Jacqueline LaPointe

Applying Merit-Based Incentive Payment System (MIPS) adjustments to Medicare Part B drug payments will restrict patient access to critical treatments, 11 medical societies recently told congressional...

Oncologist Org Opposes MedPAC Medicare Reimbursement Changes

by Jacqueline LaPointe

The Community Oncology Alliance (COA) recently expressed concerns that proposed Medicare reimbursement changes for Part B services from the Medicare Payment Advisory Commission (MedPAC) would drive...

CPC Initiative Improves Care Delivery But Not Medicare Spending

by Catherine Sampson

Although the Comprehensive Primary Care (CPC) initiative lead to progress in primary care delivery, it has not caused improvements in Medicare spending, patient experience or quality of care, researchers...

Could More Competition Reduce Rising Prescription Drug Costs?

by Vera Gruessner

Prescription drug costs seem to be higher than ever before. Merrill Matthews, Resident Scholar at the Institute for Policy Innovation, wrote about some of the reasons behind these high prices and the...

How Value-Based Care Payment Improves Patient Outcomes

by Vera Gruessner

Last month, the Centers for Medicare and Medicaid Services (CMS) released a new value-based care payment system for Medicare Part B drug prescribing protocols of physicians. Medicare Part B is a program...

CMS Rule Addresses Medicare Fraud, Overpayment Compliance

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) published a final rule this week focused on improving Medicare compliance, reporting, and self-identified overpayments to...

CMS’s Medicare Drug Spending Dashboard Notes Spending Spike

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) has released a Medicare Drug Spending dashboard to address prescription drugs’ affordability. CMS aims to make drug spending trends more...

CMS Confirms More Affordable 2016 Medicare Part B Premiums

by Jacqueline DiChiara

Healthcare consumers’ wallets will apparently be a tad fuller next year. 2016 will not see a cost of living increase for those under Social Security, according to an announcement from the...

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