Hospital-Administered Drugs. Beginning on January 1, 2016, when a hospital independently bills for prescription drugs on ODM’s provider-administered pharmaceuticals fee schedule, reimbursement will be based on the fee schedule amount. To the extent the drug is not on the fee schedule, the drug will continue to be reimbursed at 60% of cost. We estimated the impact to applicable services in the 2014 encounter data under the prior and new reimbursement methodologies. The percentage reimbursement change was calculated at the rate cell and category service level and weighted by unaffected expenditures in the Outpatient – Other and Emergency Room – Other categories of service.
Hospital-Administered Drugs. Effective January 1, 2016, when a hospital independently bills for prescription drugs on ODM’s provider- administered pharmaceuticals fee schedule, reimbursement is based on the fee schedule amount. To the extent the drug is not on the fee schedule, the drug continues to be reimbursed at 60% of cost.
