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(iv) Determining national per capita expenditures for Parts A and B services under the original Medicare fee-for-service program for assignable beneficiaries for purposes of capping the regional adjustment to the ACO's historical benchmark according to 425.601(a)(8)(ii)(C) and 425.656(c)(3), capping the prior savings adjustment according to 425.658(c)(1)(ii), capping the prepaid shared savings multiplier according to 425.640(f)(2)(v), and calculating the HEBA scaler according to 425.662(b)(2)

As part of our holistic review of how best to update our data and offer interested parties additional information that addresses some of the concerns raised, we have recently improved our current suite of public use files (PUFs) by including a new file that shows estimated specialty payment impacts at a more granular level, specifically by showing ranges of impact for practitioners within a specialty

As discussed above, we believe it is appropriate to propose different policies for determining payment limits for single and multiple source drugs when negative or zero manufacturer's ASP data is reported because of statutory differences in the payment limit calculations

The primary care team books the patient for a same-day urgent care appointment to assess for signs of swelling and pleural edema