Pharmacy Question for the Week of May 14, 2018

Pharmacy Compliance Question of the Week

Question:

We are looking for clarity about billing for immunosuppressive drugs. If a supplier mailed an immunosuppressive drug shortly before the end of a beneficiary’s inpatient stay and used the mailing date as the date of service, would the claim be rejected if this happened because the claim’s date of service preceded the beneficiary’s date of discharge?

Answer:

Previously, the claim could be rejected, according to the Centers for Medicare & Medicaid Services (CMS). However, in a recent document, CMS clarified that a supplier can use the discharge date as the date of service if mailing immunosuppressive drugs one or two days before discharge.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.