A self-administered drug notice you can give patients
Given the crackdown on self-administered medication, many hospitals are choosing to give Medicare beneficiaries ABNs warning them they may have to pay for these drugs themselves, says Charles Cataline, health policy director for the Ohio Hospital Association. Even in Ohio, where the FI has said ABNs aren't needed for these drugs, it's still a good idea to give patients advance warning, Cataline adds. If for no other reason, it will help ease potential problems with patients who can't understand why they suddenly are paying for drugs they thought were covered.
With that in mind, one three-hospital system has devised a form that informs Medicare beneficiaries that they will have to pay for self-administered drugs. It may not always make patients happy to hear they might have to fork over cash, but "it's better to take your castor oil upfront," says Dean Wiler, compliance officer for MedCentral Health System, Mansfield, Ohio.
MedCentral's form also informs beneficiaries that Medicare doesn't cover screening exams. The form says:
"As a Medicare beneficiary, it's important that you are aware of items that are not covered under Medicare. Self-administered drugs are not covered. These include most prescription drugs and medicines taken at home, including: aspirin and other pain relievers; cold medicines; suppositories; nicotine patches; and injections that can be self-administered, such as calcitonin or insulin. You are responsible for the cost of these medications.
"Medicare also does not pay for screenings, except for Pap smears and mammograms. When you come to a MedCentral facility and are undergoing a screening that is not covered by Medicare, you will be asked to sign a waiver and you will be responsible for the cost of the procedure.
"However the following items generally are covered: drugs that cannot be self-administered; blood-clotting factors for hemophilia; certain oral and anti-cancer drugs; injectable osteoporosis drugs; and immunosuppressive drugs used during the first year after an organ transplant. Also covered are prescription drugs received in a skilled nursing facility.
"This is not a change in Medicare policy, but these are rules you should be aware of, especially in light of the increased attention by the government to hospital billing procedures. MedCentral Health System also thinks it's important you know this because you will be responsible for the cost of items not covered by Medicare.
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