Adjusting Outpatient Claims for Drugs Paid Incorrectly

Current Status
3/1/2019: CMS has instructed MACs to adjust outpatient claims reporting specific drugs that were incorrectly paid. All MACs will complete these adjustments by July 1, 2019.

Situation:
The Centers for Medicare & Medicaid Services (CMS) is aware of an issue with outpatient services that ties to Change Request (CR) 11016 (PDF, 123 KB), January 2019 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files. A file data error has been discovered where the rates for two (2) Drug Codes were incorrectly priced in the October, 2018, restated file and five (5) Drug Codes were incorrectly priced in the January, 2019, file. This error caused the affected claims to be paid incorrectly. CMS implemented ASP drug file corrections retroactive to October 1, 2018, for the October restated file and to January 1, 2019, for the January file. 

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