Price Increase for Macroaggregated Albumin (MAA)

Question:
How does the price increase for macroaggregated albumin (MAA) affect the average Medicare patient? Who absorbs the cost?

Answer:

In the hospital outpatient setting, the facility absorbs the increased cost for, at a minimum, the first two years. Hospitals must immediately update their charge masters to show the increase so that, following those two years, rates can potentially go up if those increases are realized in the hospital outpatient claims data.

In the physician office setting, payers typically pay based on invoices. Therefore, providers in this setting may be able to recoup costs up to the payer maximum allowable set by each payer. If the allowable is not set high enough, the physician office should work with the local Medicare Administrative Contractors (MACs) or payer on raising their allowables accordingly. Sample invoices are likely necessary to be supplied to the medical director MACs in the physician office setting. MACs and payers are flexible and can make changes in months rather than years. Conversely, the Hospital Outpatient Prospective Payment System (HOPPS) is locked into a two to three year lag, depending on timing. The most important item for a hospital, is the update the charge master with new cost/charge information as soon as the increase is implemented.

The opinions referenced are those of the members of the SNMMI Coding and Reimbursement Committee and their consultants based on their coding experience. They are based on the commonly used codes in Nuclear Medicine, which are not all inclusive. Always check with your local insurance carriers as policies vary by region. The final decision for the coding of a procedure must be made by the physician considering regulations of insurance carriers and any local, state or federal laws that apply to the physicians practice. The SNMMI and its representatives disclaim any liability arising from the use of these opinions.