Compound Medications are a big money making scheme.
The doctors have candy bowls of them in their offices and hand them out like suckers. But it's the ICs that have been the suckers.
A few years back when all this started the examiners would get the bills and they did not even know what the bills were for, but if they were prescribed by the PTP them they'd stamp Ok to Pay and along they went to bill review. Bill review did not recognize this new scheme at first either, so they went along and paid. Everyone trying to be timely, meet their quotas, etc. So these companies keep making money so they keep doing it. Some Drs. opening their own companies to distribute these medications as they realized the money making potential. (Capen = nepac)
They give them their 3 day supply and then they start shipping them to their house every month. The Drs never bothered to request authorization.
The applicants say they don't work and they don't even use them. Then along come these third parties collecting on them. It's never quite clear what pharmacy actual made them or why they were prescribed in the first place. They bill hundreds of times in excess of the fee schedule. And unfortunately, some ICs pay them or some percentage to get rid of them. Even 10% can be more than the actual fee schedule.
Compound medications are supposed to be made individually for one patient. Specific to that patient. And only after other standard traditional medications have been given and the patient has had no relief or for some other medical reason could not take or tolerate orals. Or perhaps when the side effects of orals are too severe. When does anyone see that the prescribing Dr every mention any trial of other medications and the the applicant was intolerant in their reporting?
The collectors are persistent and aggressive. They do not listen to valid arguments such as: self-procured; not authorized: not in accordance with the MTUs; prescribed by a non-MPN Dr.; not incorporated in the Dr's reporting; and LC 5402 (c) - dates of service after the denial on a claim denied AOE/COE and the PQME found no injury. They just call and call and want money.
quoted from hereThe doctors have candy bowls of them in their offices and hand them out like suckers. But it's the ICs that have been the suckers.
A few years back when all this started the examiners would get the bills and they did not even know what the bills were for, but if they were prescribed by the PTP them they'd stamp Ok to Pay and along they went to bill review. Bill review did not recognize this new scheme at first either, so they went along and paid. Everyone trying to be timely, meet their quotas, etc. So these companies keep making money so they keep doing it. Some Drs. opening their own companies to distribute these medications as they realized the money making potential. (Capen = nepac)
They give them their 3 day supply and then they start shipping them to their house every month. The Drs never bothered to request authorization.
The applicants say they don't work and they don't even use them. Then along come these third parties collecting on them. It's never quite clear what pharmacy actual made them or why they were prescribed in the first place. They bill hundreds of times in excess of the fee schedule. And unfortunately, some ICs pay them or some percentage to get rid of them. Even 10% can be more than the actual fee schedule.
Compound medications are supposed to be made individually for one patient. Specific to that patient. And only after other standard traditional medications have been given and the patient has had no relief or for some other medical reason could not take or tolerate orals. Or perhaps when the side effects of orals are too severe. When does anyone see that the prescribing Dr every mention any trial of other medications and the the applicant was intolerant in their reporting?
The collectors are persistent and aggressive. They do not listen to valid arguments such as: self-procured; not authorized: not in accordance with the MTUs; prescribed by a non-MPN Dr.; not incorporated in the Dr's reporting; and LC 5402 (c) - dates of service after the denial on a claim denied AOE/COE and the PQME found no injury. They just call and call and want money.
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