New Billing and Prescribing Procedures
The business of caring for patients is affected by the new law, and Independence Blue Cross can help companies understand how this will affect their organization.
- Billing for office visits — when cost-sharing is applicable, and when it is not
- Over-the-counter prescriptions — some medications available without a prescription will require one for reimbursement purposes
Billing for Office Visits
For recommended preventive services billed separately from an office visit, cost-sharing may be applied to that visit. If such services are not billed separately from an office visit, and the primary purpose of the visit is the delivery of such item or service, then cost-sharing requirements may not be imposed with respect to the office visit.
However, for recommended preventive services not billed separately from an office visit where the primary purpose of the office visit is not the delivery of that service, then cost-sharing may be applied to the office visit.
As of January 1, 2011, over-the-counter drugs and medicines no longer qualify for reimbursement from health plan spending accounts. If you have patients with a Health Reimbursement Account (HRA), Health Savings Account (HSA) or Flexible Spending Account (FSA), and you determine the patient needs an over-the-counter medicine (other than insulin and diabetic supplies), a prescription for the over-the-counter medicine is required for the patient to receive reimbursement for qualified medications with funds from their health account.
Please consult these lists regularly, as they are projected to change from time to time.
OTC medications requiring a prescription:
OTC medications and supplies that do not require a prescription: