Hazy RX Medical Billing Question

Medical billing denials can be a blessing if your facility is conducting dangerous practices. A common, yet dangerous practice used in many hospitals is the dispensing of medications without an examination. Not only is this type of practice illegal, but it also puts the health of your patients in jeopardy. A medical billing denial for such practices may mean there is something wrong with the way you conduct business.

If a patient visits their local family practice doctor, and the doctor decides the patient needs a certain medication, they should receive that medication from a pharmacy. Some family physicians send their patients directly to an emergency department. They call the emergency department physician and tell him/her who will be arriving and what medication they need. When the patient registers, they receive the medication from a nurse and leave. Not only is there no examination, but the physician doesn’t even see the patient. Hospitals cannot get medical billing reimbursement for medication disbursement alone.

Medical billing denials should not be your number one concern when conducting business in this manner. The practicing license of the emergency department physician is in jeopardy. If something were to happen to the patient after leaving the hospital, the emergency department physician would be at fault. Currently there is a lawsuit for this exact medical billing situation. An emergency department physician did not examine a patient before giving a shot of meperidine. The patient had a subarachnoid hemorrhage.

Secondly, pharmacies have special medical billing licenses for disbursing medications. Your hospital cannot get medical billing reimbursement without a licensed pharmacist , a licensed pharmacy, or without the patient receiving specific information regarding the medication.

In this type of situation, nonpayment may send up red flags. Medical billing nonpayment may be a blessing for your facility.

View all Articles by: Melissa Clark, CCS-P