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Chris Cusimano Nov 16, 2023 10:55:39 AM 2 min read

ACTION ITEMS: 340B Underpayments

In August, GDS blogged about our work on dissecting, quantifying, and reconciling the 340B underpayment remedy into beneficiary and Medicare portions to completely understand all facets of the situation. Addressing 340B underpayments and the remedy therefore requires an understanding of what is and is not addressed by the Final Rule, rebilling, proposed lump sum verifications, determining potential legal action for unfair treatment, and establishing a plan of action for Medicare Bad Debt implications. 

The Final Rule noted that some providers had found incorrect amounts in Exhibit AAA to the Proposed Rule. GDS encourages providers to verify the amounts in Exhibit AAA. Providers have the right to submit challenges to Exhibit AAA until and including 11/30/2023. GDS is performing this service for clients.

Unfair treatment in the 1/1/2022-9/27/2022 period resulted when a provider received increased beneficiary amounts as an amount to be collected upon (because of doing the optional rebilling) instead of receiving the amount as a lump sum payment. To understand this amount and the pathway to claim payment from CMS, a provider needs to first quantify the additional beneficiary portion for 340B claims that were rebilled. GDS is performing this service for clients.

The increased beneficiary responsibility resulting from 340B adjustment claims for dates of service in 2022, require Medicare Bad Debt considerations. Providers should continue to inspect this area and to consider a comment to CMS that they were in fact not “made whole” in the same period as peers who did not opt to submit adjustment claims. 

Providers were disappointed that the final rule provided little hope for relief in addressing the underpayments they received from MA Medicare payors. Along with a fresh review of MA Medicare contracts, GDS recommends providers to model their Medicare Advantage 340B claims and payments and quantify underpayments. Thereafter, providers may seek recourse with those MA Medicare payors. GDS is helping clients capture additional MA 340B underpayment revenue through rebilling, lump-sum settlement, and/or legal action. 

For more information, contact to schedule a 30-minute discussion to include data needed and pricing for these services.