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Delayed Implementation of Required 340B Modifiers: KY Department of Medicaid Services

We wanted to share an urgent update on the impending billing changes that were scheduled to take effect on 4/1/2020. In a communication we acquired today from Jessin Joseph, Pharmacy Director with KY Department of Medicaid Services, it was announced the Department has made the decision to delay the implementation of the required 340B modifiers indefinitely. Once the state of emergency has been lifted, the Department will reevaluate and communicate an appropriate date of implementation. The Kentucky DMS Pharmacy web page should be updated shortly to reflect this announcement.

We will continue to monitor this and will provide updates as we get them. If you have any questions or would like to discuss further, please contact our 340B team.

Please continue to monitor our Coronavirus Resources and Information Page and COVID-19 Relief & Operations FAQs for updates.

340B Reimbursement Update

Medicare Part B Reimbursement Cuts To 340B Hospitals

In 2018, the Center for Medicare & Medicaid Services (CMS) implemented a change in reimbursement for DSHs, RRCs, and non-rural SCHs for Medicare Part B drugs obtained through the 340B Program, adjusting reimbursement amounts based on a value of Average Sales Price (ASP) – 22.5% from the previous value of ASP + 6%. This was […]

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HEALS Act vs. HEROES Act: Our Comparison

HEALS Act vs. HEROES Act: Our Comparison

On July 27th, Senate Republicans introduced their version of an additional round of economic stimulus and coronavirus response in the form of the Health, Economic Assistance, Liability Protection and Schools (HEALS) Act. In comparison to the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act introduced by House Democrats back in May, the HEALS Act […]

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PAC Billing Codes

Denied Claims due to Billing Codes

A new issue is affecting some inpatient hospital and Skilled Nursing Facility (SNF) claims when an interrupted stay is billed at the end of the month. The system incorrectly assigns edits U5601-U5608 (overlapping a hospital claim). If you billed the interrupted stay correctly, and your claim is rejected, modify your billing so the claim spans […]

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