Friday, August 29, 2014

Question of the Day August 29, 2014 Should PBMs recoup claims and immediately terminate Network Proviider for all claims relating to compounding pharmacies who have been using form/check the box that were in violation of the Provider Manual? How much total money could be recouped from this violation alone?

 

1 comment:

Anonymous said...

Pre-printed prescriptions were at issue with respiratory (nubulizer) compounding decades ago, leading to questionable reimbursements under Medicare Part B (the unapproved drugs may not have been intended by prescribers, and, at the very least, the preprinted forms did not include material facts about the products--seems they have resurfaced here, particularly with respect to pain cream concoctions. Claims are made on the benefit side, with little or no risk disclosure.