Entries by Sara Hathaway, PharmD

The HIPAA Hot Seat: What You Need to Know About the “2024 Privacy Rule” and Reproductive Health Care

February 8, 2025

The 2022 Dobbs v. Jackson Women’s Health Organization ruling, which overturned Roe V. Wade, prompted modifications to the Privacy Rule (45 CFR Parts 160 and 164). The Biden-Harris administration, partially through President Biden’s Executive Order (EO) 14076, aimed to better protect information related to reproductive health care, to bolster patient-provider confidentiality, and promote trust between […]

2025 PAAS Fraud, Waste & Abuse and HIPAA Compliance Program Updates

January 14, 2025

PAAS National®®® continuously monitors legislative and regulatory changes that may impact your Fraud, Waste & Abuse and HIPAA Compliance Program. We keep a close eye on enforcement from the Department of Justice, Office of Inspector General, State Attorney Generals, and Office for Civil Rights to help ensure the program meets interpretative standards. Furthermore, PAAS works […]

CMS Updates HIV PrEP Supply Fee Code, Effective 01/01/2025

January 6, 2025

In December 2024, PAAS National®® brought you the Medicare Part B Coverage of HIV PrEP Newsline article which provided an in-depth look into appropriately billing HIV PrEP medications to Medicare Part B. The original shift from billing these medications from Medicare Part D to Part B was effective just a few months ago (September 30, […]

Medicare Part B Coverage of HIV PrEP

December 14, 2024

As of September 30th, 2024 there was an industry shift from billing HIV Pre-Exposure Prophylaxis therapy (PrEP) from Medicare Part D to Medicare Part B. This shift to Part B coverage falls under section 1861(ddd)(1) of the Social Security Act using the “additional preventative services” benefit. Due to the high cost of HIV PrEP medications, […]

Avoid This Billing Pitfall with Your Medicare Part B Nebulizer Solution Claims

November 16, 2024

Correctly billing Medicare Part B can be tough. The Local Coverage Determinations and associated Policy Articles for each DMEPOS category, along with the Standard Documentation Requirements for All Claims Submitted to DME MACs, are filled with billing and documentation guidelines which suppliers must fully comprehend and follow to avoid claim chargeback.