In July, GDS blogged about the proposed remedy for the well-known illegal 340B payment policy. Subsequently, client demand prompted GDS to develop a tool that calculates provider-specific payments using the legal methodology (ASP + 6%) versus the erroneous payment methodology (ASP – 22.5%). This includes a dissected look at the Medicare and patient responsibility portions. GDS experts then created a process for analyzing the results from the perspective of all remedies available to providers. That perspective also considers the actual court ruling on this matter and ends with the known implications from GDS’s deep understanding of Reimbursement and Revenue Cycle processes.
GDS believes every provider should verify provider-specific, lump sum estimates in Addendum AAA to the proposed rule and re-processed claims. Our tool empowers providers to verify and understand these amounts. Additionally, strong consideration should be given to seeking a complete understanding of the issues from the court ruling all the way to possibly challenging all or certain aspects of the proposed remedy. To date our tool, analysis, and research indicate providers should not accept the proposed remedy at face value.
The proposed remedy includes decreased payments via a reduction in the conversion factor over the next 16 years for all providers to achieve budget neutrality for the years the erroneous policy was applied. All providers with non-pharmacy items and services, especially non-340B providers, should be considering strategies to eliminate this large risk.
GDS encourages all providers to comment on various items within the proposed rule by the September 5, 2023* deadline.
*On Tuesday, September 5, 2023, CMS will publish an extension of the comment period. The comments will be due by September 11, 2023.
