Billing on the Pharmacy Side: Pitfalls and Compliance Considerations When Billing PBMs, Medicare Part D Plans and PSAOs
Tuesday, April 7, 2020
9:15 AM – 10:15 AM
Location: Red Rock 8-9
From point-of-sale electronic claims submission to navigating network access, from arranging for nursing services to delivering the medications, the process for submitting "pharmacy" claims to PBMs adheres its own and unique set of rules and requirements. Home infusion pharmacies face a unique set of contractual requirements spelled out in lengthy PBM manuals, in addition to home infusion-specific rules under Medicare Part D. This lecture will cover the unique PBM contractual compliance considerations, including home infusion-specific networks, PBM credentialing, pharmacy audits, and network access. The lecture will also cover the Medicare Part D program benefit, and the role of home infusion providers.
Compare and contrast the differences when billing home infusion drugs to a pharmacy benefit versus a medical benefit.
Describe the pharmacy benefits landscape for home infusion providers.
Conduct themselves in compliance with PBM and Medicare Part D contractual and regulatory requirements.