Pharmacy Question for the Week of April 15, 2019

Pharmacy Compliance Question of the Week

Question:

When do retroactive payment corrections occur for certain drugs?

Answer:

Based on average sales price (ASP) methodology, some drugs and biologicals will have payment rates that are corrected retroactively. These corrections typically occur on a quarterly basis. The list of drugs and biologicals with corrected payments rates will be accessible on the CMS website on the first date of the quarter at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/OPPS-Restated-Payment-Rates.html. Providers may resubmit claims that were impacted by adjustments to previous quarter’s payment files.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.