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- Congressional Mandate: Noncovered Versions of Part B Drugs in 2023-2024
Office of Inspector General | U S Department of Health and Human Services
- Effects of Including Noncovered Versions of Stelara Biosimilars in Part . . .
Office of Inspector General | U S Department of Health and Human Services
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- Medicare Payments for Clinical Diagnostic Laboratory Tests in 2023
Medicare is the largest payer of clinical diagnostic laboratory services in the United States Medicare Part B covers most lab tests and pays 100 percent of allowable charges without patient cost-sharing obligation The Protecting Access to Medicare Act of 2014 (PAMA), Pub L No 113-93, requires CMS to set payment rates for lab tests using current charges in the private health care market
- Ensuring Dual-Eligible Enrollees Access to Drugs Under Part D . . .
Dual-eligible enrollees are enrolled in both Medicaid and Medicare, and they receive prescription drug coverage under Medicare Part D As long as Part D plans abide by certain limitations outlined in 42 CFR § 423 120, Part D sponsors have discretion to include different Part D drugs in their formularies As required under section 3313 of the Patient Protection and Affordable Care Act, we will
- Comparison of Average Sales Prices and Average Manufacturer Prices . . .
When Congress established average sales price (ASP) as the basis for Medicare Part B drug reimbursement, it also provided a mechanism for monitoring market prices and limiting potentially excessive Medicare payment amounts Section 1847A (d) (1)- (3) of the Social Security Act mandates that OIG compare ASPs with average manufacturer prices (AMPs) and widely available market price (if any) If
- Optometrists Billing for Part B Services for Medicare Enrollees in . . .
Optometrists Billing for Part B Services for Medicare Enrollees in Nursing Facilities Medicare Part B covers many medical services (e g , optometry services, mobile x rays, and psychological therapy) provided to enrollees, including those residing in nursing facilities (NFs) NFs are required to provide services necessary to ensure their residents attain or maintain sound health Sometimes, an
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