Specialists bill more often for Part B drugs
Research conducted by Avalere consultants showed that specialists such as oncologists, rheumatologists, and ophthalmologists more frequently bill for Part B drugs compared with physicians from primary care specialties.
“As a result, Part B drugs represent a larger percentage of total billed Medicare allowed charges for these specialists,” and they “could see substantially higher payment penalties or rewards than their counterparts who administer fewer Part B drugs,” they noted.
Moreover, the level of financial risk for certain specialties will continue to rise as implementation of the MIPS program progresses over the next few years. For example, payment adjustments for rheumatologists and oncologists could increase or decrease by as much as 29% in performance year 2020. For urology, Avalere estimated that payments could increase or decrease by as much as 11% during that period.
Before MIPS went into effect, CMS programs including the Physician Quality Reporting System, Physician Value-Based Payment Modifier, and the Medicare Electronic Health Record Incentive only pertained to physician fee schedule services and did not include the cost of Part B drugs.
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