PROVIDERSMUSTWAITUNTIL FALL FORCMS 340B REMEDY

Meanwhile, in October of 2022, Medicare Administrative Contractor Novitas Solutions (Jurisdiction JH) offered to reprocess any discounted 340B payments made in calendar year 2022 at the full APC rate; however, no other MAChas followed this example, including Novitas Solutions in Jurisdiction JL.

The Jurisdiction JH MACoffer to reprocess 2022 claims is found at the link below: https://www novitas-solutions com/webcenter/portal/MedicareJH/pagebyid?contentId=00259704

Withtheintroductionof theNoSurprisesAct,PriceTransparencyfor theinsuredindividual has becomeconfusedwiththeGoodFaithEstimatefor theuninsuredindividual.

It?s important to understand the difference of an estimate generated for an individual under the Price Transparency law and an uninsured individual under the No Surprises Act Price Transparency Tool (PTT) The PTTis a patient-facing online tool meant to be used by patients who are shopping for services prior to scheduling. These individuals can be insured or uninsured

The desired service must be available as a shoppable service to generate an estimate with the PTT Although generating an estimate for services involves a variety of contractual discounts and health insurance plan information, the PARA Price Transparency Tool (PTT) allows the patient to determine their cost from the provider-based web portal

More information about the PARA PTTcan be found at this link:

PARA Price Tranparency Tool - Sept 2021 pdf (para-hcfs com)

UNDERSTANDINGESTIMATESIN PRICETRANSPARENCY &NO SURPRISES

PARA Dat a Edit or (PDE) Charge Quot e

When the patient is having trouble accessing or navigating the PTT, or the desired service is not a shoppable service, the Charge Quote tab of the PARA Data Editor (PDE) can be used by PDEUsers to generate a quote These quotes are not mandated by any laws, but the benefits of providing cost estimates prior to scheduled services include:

- Providing price transparency

- Providing estimates prior to service, avoiding unexpected financial liability

- Reducing Patient dissatisfaction directed at the provider

- Increasing self-pay collections while decreasing bad debt

The Charge Quote tool is available to PDEUsers under the Charge Quote tab