June 2016
This issue includes an overview article on the MACRA or the Medicare Access and CHIP Reauthorization regulation.
CMS recently posted two major proposed rules for calendar year 2017, including the Medicare Inpatient Prospective Payment System rule, which covers hospital inpatient payments, and–MACRA, which covers CMS’s proposed rule to respond to Congressional direction to move the Medicare program from a fee for services payment model to a “valuebased” purchasing model. The bottom line on MACRA is, nearly all Medicare participating physicians will find future Medicare payments tied to how physicians do on an index of performance measures. The index includes a mix of cost, quality, electronic data use and clinical practice improvement activities. A third important rule, the Medicare Physician Fee Schedule, which covers Medicare Part B payments to physicians and other Part B providers, is expected shortly for 2017.
A new class of drugs – monoclonal antibodies for the treatment of asthma – are proliferating the market. These new drugs will require practices to consider the buy-and-bill model for these physician administered drugs. This issue includes an article on the buy-and-bill reimbursement model and how it will likely apply to these new asthma medications.
EBUS billing to avoid problems with NCCI edits is also covered in this issue. As always, you can find answers to your pulmonary, critical care and sleep coding
and billing questions.
I hope this issue provides useful information for you and your practice. I will welcome your input on topics to cover in future issues.
Sincerely,
Alan L. Plummer, MD
Editor
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Medicare Access and Chip Reauthorization Act of 2015 (MACRA)
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Physician Administered Asthma Drugs and Buy and Bill Reimbursement Model
- Masthead
