Complete Story
 

09/07/2022

CMS 365-Day Lookback Period

Medicare Advantage plans are required to conduct a 365-day lookback on the beneficiaries’ claims to ensure there are no prior administrations of the Part B drug that would otherwise exempt the patient from the step edit policy [(Source:  42 CFR §422.136(a)(1)].

The step edits imposed by Medicare Advantage plans on Part B drugs apply only to new patients, and not patients continuing prior therapy. 

MORE INFORMATION 

Printer-Friendly Version



Report Broken Links

Have you encountered a problem with a URL (link) on this page not working or displaying an error message? Help us fix it! 
Report Broken Link