HCPro, JustCoding Outpatient - 2018 Issue 17 (April)
Healthcare News: AHA advises providers to file redeterminations for 340B drug claims
April 24th, 2018
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Article Overview
This news item explains the current legal and payment-policy context surrounding Medicare reimbursement for 340B-acquired drugs under the outpatient prospective payment system. It focuses on why providers may want to consider redeterminations now, how the AHA’s lawsuit against CMS could affect future repayment outcomes, and the broader administrative and budgeting issues involved. The article is intended for hospital revenue cycle, reimbursement, and compliance professionals monitoring Medicare drug payment policy and litigation.
Why This Topic Matters
Providers affected by the 340B payment policy may need to understand how to preserve appeal rights while litigation is pending. The topic matters for hospitals, reimbursement teams, and compliance staff tracking OPPS payment changes and potential retroactive relief.
What You Will Learn
- The legal and payment-policy backdrop for the 340B drug reimbursement dispute
- Why providers are being advised to consider preserving appeal rights
- How CMS budget neutrality and OPPS payment changes factor into the issue
- The administrative challenges involved in reversing or recalculating affected payments
Who Should Read This
- Hospital revenue cycle staff
- Reimbursement specialists
- Compliance professionals
- Medicare billing teams
- Healthcare administrators
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