7 things providers should expect from Medicare going forth into 2016

Mary Rechtoris - Print  |

Lindsay Conway, the managing director of Advisory Board Company, outlined what providers should expect from Medicare this year at the Association of Community Cancer Centers annual meeting in Washington, D.C., according to AJMC.com.

Here are seven things to expect:

1. CMS pays physicians and hospitals the average sales price of a drug and an additional 6 percent to cover handling and administration. This will likely not be the case for Medicare B drugs, as the CMS proposed a model with a lower add-on payment for Medicare B drugs by the end of 2016.

2. While biosimilars may possibly reduce the cost of care for Medicare, the margin of payment will remain the same for providers.

3. Although radiation therapy reimbursement is fixed, the more complex radiation therapy modalities are experiencing a slight reimbursement increase. The less complex therapies are seeing slight reduction in payments.

4. This year, CMS is offering reimbursement for lung cancer screenings.

5. Hospital outpatient departments will try new oncology-specific measures, which will fall under the physician reporting system.

6. In 2017, the CMS will utilize patient surveys, but has yet to decide which survey they will use.

7. Following CMS repealing the sustainable growth rate patchwork formula, physicians should expect a 0.5 percent increase in physician payment through 2019.

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