FFS (Fee-for-Service Medicaid)
Definition
Fee-for-Service (FFS) Medicaid is the traditional Medicaid payment model where providers submit claims for each service rendered and are reimbursed based on the state’s fee schedule. Under FFS, the state Medicaid program directly reimburses providers and collects manufacturer rebates through the Medicaid Drug Rebate Program.
In the 340B context, FFS Medicaid is specifically relevant to duplicate discount prevention. The Medicaid Exclusion File (MEF) is designed to prevent duplicate discounts in the FFS context by identifying which covered entity sites are billing Medicaid FFS for 340B drugs and signaling state agencies not to request manufacturer rebates on those claims.
As Medicaid has shifted significantly toward managed care, FFS Medicaid now represents a smaller share of total Medicaid enrollment in many states. However, FFS duplicate discount prevention remains important for covered entities that have FFS patients.
Frequently Asked Questions
Why FFS (Fee-for-Service Medicaid) Matters
FFS Medicaid is the context in which the MEF prevents duplicate discounts. Understanding the distinction between FFS and managed care Medicaid is essential for managing duplicate discount prevention obligations.
How Virtue 340B Uses It
Virtue 340B evaluates FFS Medicaid billing practices and MEF accuracy as part of our audit and consulting services.