tci Medicare Compliance & Reimbursement - 2007 Issue 45
Part D: Team Up With Docs To Keep Benefits Strong
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Article Overview
This article is a practical, nontechnical guide for pharmacies and other billing or reimbursement staff working with Medicare Part D coverage exceptions. It describes the role of a physician-backed supplemental letter, the general situations it is intended to support, and the kinds of information that should accompany a plan exception request. It is relevant to readers who help patients maintain access to covered medications and coordinate documentation with prescribers.
Why This Topic Matters
Coverage exceptions can affect whether a patient continues to receive needed medication without interruption. This article matters because it outlines the documentation workflow and communication points that can help support exception requests with a plan.
What You Will Learn
- Why a physician letter may be used with a plan exception request
- What general patient and medication information the letter template includes
- How the template addresses different exception request situations
- How pharmacies and physicians can coordinate supporting documentation for Part D coverage issues
Who Should Read This
- Pharmacists
- Pharmacy billing staff
- Medical office staff
- Physicians
- Medicare Part D coordinators
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