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Medicare Compliance & Reimbursement

COMPLIANCE:

You Need To Tread Carefully When Billing For Part B Drugs

Published on Thu Aug 10, 2006

Physicians can write a Part D diagnosis on prescriptions to avoid hassles.

Physicians can't bill Medicare for Part B drugs unless they can prove that they administered them in the office.

The U.S. Attorney's Office announced a settlement in which a medical practice agreed to pay just under half a million dollars to settle allegations that it billed Medicare improperly for drugs.

The practice billed as if the physician had administered the drugs, when in fact the patients took the drugs home to administer themselves.

Even if a drug isn't on the list of "usually self-administered drugs," you can't bill for it unless a provider administers it in the physician's office, cautions Noridian Administrative Services.

In related news, physicians should have less trouble from now on when a drug could be covered under Part B or Part D of Medicare, the Centers for Medicare & Medicaid Services (CMS) says in MLN Matters article SE0652.

Prescription drug plans (PDPs) can't pay for Part B-covered drugs, but some drugs have dual uses. For example, Part B only covers prednisone when it's used to prevent organ rejection for transplant patients. Some PDPs imposed cumbersome "prior authorization" procedures for Part B/Part D covered drugs, but CMS has told the PDPs to cover those drugs whenever the prescription includes the words "Part D" and a Part D-covered diagnosis, such as "contact dermatitis."

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