Rejections of drug claims for nursing home residents under Medicare Part D.
Some nursing facility administrators and physicians have raised concerns about the increased administrative burden of working across multiple Part D prescription drug plans (PDPs), citing the possibility for adverse resident outcomes and financial burden on facilities when PDPs reject drug claims for residents. We examined data on claims in rejected status for one large long-term care pharmacy as of December 2006. There was considerable variation across PDPs in both rejection rates and reasons for rejection.
Huskamp
Haiden A
HA
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. huskamp@hcp.med.harvard.edu
Stevenson
David G
DG
Keating
Nancy L
NL
Newhouse
Joseph P
JP
D006801:Humans; D007345:Insurance Claim Review; D007349:Insurance, Health, Reimbursement; D054524:Medicare Part D; D009735:Nursing Homes / Q000706:statistics & numerical data*; D014481:United States