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Third Party Contracts and the Compounding Pharmacy

Author(s):  Heckman H Edward

Issue:  Jul/Aug 1998 - Dermatology
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Abstract:  Unfortunately, reimbursement formulas do not measure up to a compounding pharmacy’s usual and customary price. Many pharmacists have been submitting claims at the usual and customary price and have experienced some very expensive third-party audit lessons. In this article, the author, affiliated with PAAS National, Inc., discusses options for on-line billing and a strategy for negotiating. He recommends negotiating a fair reimbursement schedule by convincing the third party that it will be better off using the “specialized services” that a pharmacy offers, and he includes tips for the necessary elements of a sales presentation directed toward this end. He concludes that the overall objective is for the third party to recognize the practice and to find it desirable to include an addendum to the contract listing preparations and charges. If successful, one can garner fair reimbursements without incurring the latent risk of huge audit recoupments.

Related Keywords: Audit, Reimburse

Related Categories: BUSINESS

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