emergent surgery use -- off label use | PTLA Message Board Posts

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Msg  6054 of 6324  at  3/10/2019 1:07:38 PM  by


 In response to msg 6051 by  watsonturtle
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Re: emergent surgery use -- off label use

"But for small hospitals, the ASP+6% program (my understanding only) will result in full reimbursement."
ASP+6%.  Average Sales Price + 6%. 
NTAP New technology add on payment. 
Let me see if I can explain this.  For example, lets say a medicare patient checks into a major hospital with an ICH.  The hospital admits him and treats him for his ICH and is reimbursed by Medicare at a flat rate irrespective of what treatment he actually received.  Because that flat rate is based on historic data, new expensive treatments do not figure into the reimbursement.  To compensate, hospitals that use these new expensive technologies can be reimbursed at 50% of the actual cost of the treatment.
Now consider a small local hospital that receives the same patient, but only provides immediate care and then transfers the patient to a larger regional center with a neuro-intensive care unit.  The small hospital is eligible for Part B reimbursement for the services provided, which can include Andexanet reimbursed at cost + 6%.  
If I have this correct, it appears to me that more of the cost gets passed on to Medicare in the transfer scenario.  Keep in mind that these are both Medicare programs and do not apply to patients under the age of 65. 

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