Pharmacy Question for the Week of July 23, 2018

Pharmacy Compliance Question of the Week

Question:

Where can I find the drugs with corrected Medicare payment rates, and can I resubmit claims to ensure we are paying the correct rate?

Answer:

Some drugs and biologicals based on average sales price (ASP) methodology will have payment rates that are corrected retroactively. These retroactive 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-forService-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.