Q4 Update: Viscosupplementation Drug Medicare ASP Reimbursement Rates

Managing a clinic's viscosupplementation business involves navigating a complex web of data, from purchase and inventory management to insurance verification and revenue collection. Any disconnect or mismanagement in this process can have far-reaching consequences for the clinic, often not apparent until much later. This article aims to provide a concise overview of how Medicare and other payers calculate reimbursement for HA medications for Q4 2024 and how these calculations can impact clinic revenue. Additionally, embedded links are provided for easy reference to the sources mentioned.

Medicare calculates the Average Sales Price (ASP) for Part B-covered drugs and biologics by using sales data provided by manufacturers, which includes any discounts, rebates, or price concessions. This data is used to determine the ASP for each drug or biologic. Medicare then reimburses providers for these drugs at a rate of ASP plus 6%. The payment rates are updated quarterly, reflecting changes in market prices and ensuring that Medicare reimbursement aligns with current drug costs.1 ?This process is designed to cap your potential profit when “buying & billing” for medications in the office setting. The problem with this method, however, is that if you are not buying the medications well you can actually lose money by administering these medications to your patients. Likewise, an opportunity exists if you align yourself with the proper Group Purchasing Organization (GPO) to purchase these medications well below the ASP rate and secure a greater profit for your business.

Integrative Practice Solutions represents the largest group of privately owned healthcare clinics with a primary focus on the non-surgical treatment of osteoarthritis of the knee & shoulder. Our patented Advanced Arthritis Relief Protocol , is a novel process of administering viscosupplementation in a manner proven over 92.7% substantially clinically effective in randomized multi-center clinical trial. With over 240 licensed clinics in more than 40 states, that have successfully treated more than half a million patients, we have developed substantial purchasing power to secure unparalleled discounts for our clients and GPO members.

This is why we are pleased to announce significantly greater profit potential with GenVisc? 850 and other viscosupplements for the final quarter of 2024! Our current GPO rates for GenVisc? 850 of $120 per syringe with no quantity limit, $116 per syringe with orders of 100+, and only $112 per syringe with orders of 250+ syringes present an enhanced profit opportunity if you order now (before October 1st). Based upon:

• Q4 CMS Allowable: $147.40
• Max GPO Discount: $112
• Profit Per Injection: $35.40

This now represents nearly DOUBLE the profit potential of GenVisc? 850 (CPT J7321, as compared to the previous quarter) with Medicare recipients! Effective October 1st, these rates will increase by $9 per syringe, so order now and realize the additional profit margin on your cases.

But this is not the only opportunity to realize enhanced profit from viscosupplements in Q4 2024. Integrative Practice Solutions is proud to be the largest private group purchaser of Hyalgan?, the original FDA-cleared viscosupplemention medication. Our clients and GPO members enjoy the market-low rate of only $55 per syringe, with no minimum quantity requirements. This represents a potential profit margin of $18.22 per syringe when utilizing Hyalgan? with Medicare recipients in the final quarter of 2024.

Previously, these cost savings and financial benefits have been limited to our clients and licensees, however for the first time ever, IPS is opening the opportunity to join our GPO group to private medical practices, medically integrated chiropractic practices, physical medicine practices, pain management, sports medicine, and privately owned hospital groups. This strategic decision has been made to further enhance our purchasing power in an effort to increase our already industry-low pricing for the benefit of our clients and members in future quarters.

To join our GPO group completely free of charge and gain access to the lowest wholesale pricing on FDA-cleared GenVisc 850?, TriVisc?, Hyalgan?, Hymovis?, Trilurion?, and other viscosupplements please call 855-854-6332 or email [email protected] today!

?

About the Author: Lance Liberti is a nationally recognized healthcare consultant and new patient marketing professional with more than two decades of practical experience in the field. His experience spans multiple areas of practice including non-surgical spinal decompression, medically supervised weight loss, aesthetic medicine, and non-operative extremity pain management. The president and CEO of Integrative Practice Solutions and Juventix Regenerative Medical Mr. Liberti specializes in assisting health and wellness professionals to integrate boutique medical services into their practices to offer non-surgical solutions to those suffering from various degenerative musculoskeletal conditions. To learn more about Mr. Liberti’s extensive experience and see examples of his work products view his LinkedIn profile here: https://www.dhirubhai.net/in/lanceliberti

?Sources:

1.????? https://www.cms.gov/medicare/payment/fee-for-service-providers/part-b-drugs/average-drug-sales-price

Legal Disclaimer: The information contained in this article is provided for informational purposes only and should not be construed as medical or legal advice on any subject matter. You should not act or refrain from acting on the basis of any content included in this article without seeking medical, legal or other professional advice. The contents of this site contain general information and may not reflect current legal developments or address your situation. We disclaim all liability for actions you take or fail to take based on any content of this article.