Update on pharmaceutical reimbursement and implications for health-system pharmacists

摘要

After studying these articles, the reader should be able to:rn1. Describe the structure of Medicare and a recent change in Medicare pharmaceutical reimbursement rules or rates, identify a current billing issue, explain the advanced beneficiary notice (ABN) process, and name a trend in the use of compendia for reimbursement decisions.rn2. Identify the process at the heart of the revenue cycle that provides the best opportunity to maximize Medicare pharmaceutical reimbursement, a common reason for claim rejection, a best practice to maximize Medicare pharmaceutical reimbursement, an advantage and a disadvantage of using specialty pharmacies, a flaw in proposed changes in rules for erythropoiesis-stimulating agent (ESA) reimbursement, and a strategy to use to avoid safety problems with ESA use identified by the Food and Drug Administration (FDA).