Medicare Part D Reimbursement

[Longhorn08]

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If I bill Medicare Part D and the reimbursement doesn't cover my cost, am I obligated to fill the Rx and take the loss?

Before you jump all over me for not knowing, please understand that I came from a clinic for uninsured patients and never had to deal with any claims.

TIA!

 

[genesis09]

legally speaking, you don't have to fill any prescriptions.

 

[PharFromNormal]

legally speaking, you don't have to fill any prescriptions.

This.

Just have a solid response to the little old lady of why you won't fill it. Up to you if you want to tell her you don't make money on it.

 

[MountainPharmD]

If I bill Medicare Part D and the reimbursement doesn't cover my cost, am I obligated to fill the Rx and take the loss?

Before you jump all over me for not knowing, please understand that I came from a clinic for uninsured patients and never had to deal with any claims.

TIA!

This is from a contract I'm reviewing right now.

14) Submission of Claims. Provider and its Participating Pharmacies agree to submit all claims to XXXXX, or its designated Claims Processor/Administrator whenever the Member's Identification Card is presented or on file with Provider unless Member expressly requests that a claim not be submitted to Plan 42 CFR §423.120(c)(3)

 

[zelman]

This is from a contract I'm reviewing right now.

Does the next item say you cannot subsequently reverse the claim?