Health Information Management

Complex compendia rules complicate reimbursement

Briefings on APCs, May 1, 2010

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In a perfect world, CMS and other payers would reimburse facilities and physicians for every oncology drug listed in a compendium.

In theory, the Secretary of HHS designated compendia that will be the basis for reimbursement. However, CMS allows the medical director of each FI or MAC to determine the application of each compendium for its beneficiaries. And that can lead to plenty of confusion, says Ronald Walters, MD, MBA, MHA, MS, associate vice president of medical operations and informatics at The University of Texas M. D. Anderson Cancer Center in Houston.
 

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