tci Medicare Compliance & Reimbursement - 2011 Issue 7

Reader Questions: ABN for Low-Paying Drugs?

Question: As you are probably aware, Pfizer is increasing the cost of Prevnar by $5.00. This is not a problem as most carriers are increasing their reimbursement to match. However, Healthnet, which is being officially consumed by United/Oxford on July 1, 2011, is not. Their answer is that they are going out of business, laying off people, and not adjusting their fee schedules whatsoever. Is this something I can pass along to my Healthnet patients for the next few months with a signed ABN or is that a violation of contract?Answer: Unfortunately, providing an advanced beneficiary notice...

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