Question:

When do retroactive payment corrections occur for certain drugs?

Answer:

Based on average sales price (ASP) methodology, some drugs and biologicals will have payment rates that are corrected retroactively. These corrections typically occur on a quarterly basis. The list of drugs and biologicals with corrected payments rates will be accessible on the CMS website on the first date of the quarter at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/OPPS-Restated-Payment-Rates.html. Providers may resubmit claims that were impacted by adjustments to previous quarter’s payment files.

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