Health Information Management

Pay-Per-View: Complex compendia rules complicate reimbursement

APCs Insider, April 23, 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. That can lead to much 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.

Continue reading "Complex compendia rules complicate reimbursement on the HCPro Web site. Briefings on APCs subscribers have free access to this article in the May issue.

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