Vacating Differential Payment Rate for 340B-Acquired Drugs in 2022 Outpatient Prospective Payment System Final Rule with Comment Period - Resolved 10/26/22

Provider/Supplier Type(s) Impacted: Outpatient

Reason Codes: Not Applicable

Claim Coding Impact: Not Applicable

Description of Issue: CMS recently provided an update in 2022-10-13-MLNC regarding the 340B-Acquired Drugs. All Medicare Administrative Contractors (MACs) were instructed to automatically adjust claims from September 28, 2022, forward. Additional guidance is provided below under Provider/Supplier action required

Noridian Action Required: Will adjust claims from September 28, 2022 forward.

Provider/Supplier Action Required:

Although MACs shall not reprocess 2022 date of service claims paid prior to 09/28/22 as contractor-initiated adjustments, MACs shall process provider-submitted adjustments to 2022 date of service claims that were paid prior to September 28, 2022. The adjustments can be submitted using type of bill (TOB) XX7 with condition code D9 and remarks indicating “340B Adjustment”.

Proposed Resolution/Solution: MACs will update the production alert when they have completed the adjustments from September 28, 2022 forward.

10/26/22 - Mass adjustments have been completed.

Date Reported: 10/20/22

Date Resolved: 10/26/22

 

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