Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Prescription Drug Rates

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 care quality. In the Trump...

Oncologist Org Fights Medicare Reimbursement Cut to Cancer Drugs

by Jacqueline LaPointe

A group representing over 5,000 independent, community-based oncologists is suing HHS over the implementation of a two percent sequester cut to Medicare reimbursement for Part B cancer drugs. The Community Oncology Alliance (COA) is...

Shifting Vaccinations to the Pharmacy Lowers Healthcare Costs

by Jacqueline LaPointe

Pharmacies can administer a wide range of vaccines to patients at significantly lower healthcare costs than physician practices and other medical settings, a new report from the Pacific Research Institute found. The literature review...

Pres Trump Eyes 340B Drug Reforms to Lower Prescription Drug Costs

by Jacqueline LaPointe

The 340B Drug Pricing Program could face some changes under the Trump Administration’s latest plan to reduce prescription drug costs. The United States had the highest per-capita prescription drug spending in 2015, the President...

HRSA Proposes Fifth Delay of 340B Drug Pricing, Penalty Rule

by Jacqueline LaPointe

The Health Resources and Service Administration (HRSA) recently proposed a one-year delay of a final rule that would implement 340B drug pricing rules and civil monetary penalties for drug manufacturers that intentionally overcharge...

CMS Targets Value-Based Purchasing, Drug Costs to Reduce Spending

by Jacqueline LaPointe

Healthcare spending is growing at an unstainable rate, and CMS aims to curb spending through initiatives that promote value-based purchasing, reduce administrative burdens, and lower prescription drug costs, CMS Administrator Seema Verma...

Oncologists Charge 9 to 51% More for Physician-Administered Drugs

by Jacqueline LaPointe

Median charges for physician-administered drugs covered under Medicare Part B were 9 to 51 percent higher at the oncologist than other specialty offices, researchers from Memorial Sloan Kettering Cancer Center and Johns Hopkins University...

340B Hospitals Delivered $26B in Unreimbursed, Uncompensated Care

by Jacqueline LaPointe

Unreimbursed and uncompensated care costs were 27.4 percent higher at Disproportionate Share Hospitals (DSH) enrolled in the 340B Drug Pricing Program in 2015 compared to non-340B acute care hospitals, according to a new analysis from...

AHA, Hospital Groups Renew Call to End 340B Drug Payment Cuts

by Jacqueline LaPointe

After a federal judge recently ruled that CMS can enforce cuts to 340B drug payments, the American Hospital Association (AHA) and 35 state and regional hospital associations resumed their efforts to end $1.6 billion in reimbursement...

Prescription Drug Rate Growth Slows, But Prices Still Rising 7.35%

by Jacqueline LaPointe

Providers should anticipate a 7.35 percent increase in prescription drug rates between July 2018 and June 2019, researchers from Vizient projected in a new study. Based on hospital and non-acute facility purchasing data from the...

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 B reimbursements despite recent...

Health Systems Form Drug Company to Combat Rising Costs, Shortages

by Jacqueline LaPointe

Intermountain Healthcare, Ascension, SSM Health, and Trinity Health recently announced that they will create a non-profit generic drug company to reduce prescription costs and alleviate critical drug shortages. With consulting services...

Prescription Drug Rates Continue to Challenge Cancer Centers

by Jacqueline LaPointe

Prescription drug rates and the costs of new treatment modalities continued to challenge cancer centers, according to the most recent Trending Now in Cancer Care survey from the Association of Community Cancer Centers (ACCC). For the...

Judge Denies Hospital Org Attempt to Block 340B Drug Payment Cut

by Jacqueline LaPointe

A federal judge recently ruled that CMS can start to reduce 340B drug payments to hospitals by $1.6 billion starting on Jan. 1, 2018, striking a blow to several industry groups that urged the court to delay enforcement of the new rule. US...

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 leaders. The medical societies,...

House Reps Aim to Stop $1.6B Hospital Payment Cut for 340B Drugs

by Jacqueline LaPointe

A new bipartisan bill intends to block CMS from enforcing a $1.6 billion Medicare reimbursement cut under the 340B Drug Pricing Program. Representatives David McKinley (R-WV) and Mike Thompson (D-CA) introduced H.R. 4392 last week. The...

Providers Who Accept Pharma Gifts Prescribe More Expensive Drugs

by Jacqueline LaPointe

Providers in the DC area who received gifts from the pharmaceutical industry tended to prescribe more drugs per patient, including more expensive, branded medications, than their peers who did not accept gifts, a recent PLoS One study...

Hospital Orgs to Sue CMS Over 340B Medicare Reimbursement Cuts

by Jacqueline LaPointe

The American Hospital Association (AHA), America’s Essential Hospitals, and the Association of American Medical Colleges (AAMC) recently announced their intentions to pursue litigation against CMS to prevent Medicare reimbursement...

Over 1,300 Hospitals Urge CMS to Withdraw 340B Drug Payment Cuts

by Jacqueline LaPointe

Over 1,300 rural hospitals and other healthcare organizations that serve low-income communities added their voices to the growing list of stakeholders opposing proposed payment cuts to the 340B Drug Pricing program. CMS proposed in July...

Advisory Group Warns CMS Against 340B Medicare Reimbursement Cuts

by Jacqueline LaPointe

The CMS Advisory Panel on Hospital Outpatient Payment recently called on the federal agency to abandon proposed changes to the 340B Drug Pricing Program in 2018, which would reduce Medicare reimbursement to qualifying hospitals for drugs...

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