Is the membership of PHARMA.org made up almost exclusively by companies that sell high priced drugs and devices?
Unless you live under a rock, you can’t miss the add campaign attacking the 340B drug program. If you “google” 340B on your computer, folks attacking 340B have made sure through “search engine optimization” that their website will be your first hit. Please feel free to give it a try as I talk.
The ads are mainly coming from PHARMA.org. An organization that, in theory, has a mission to “conduct effective advocacy for public policies that encourage the discovery of important, new medicines for patients by biopharmaceutical research companies.”
What are their complaints about the 340B program?
First, they allege that patients are paying more because the savings from 340B discounts is not passed down to the patient. I would argue that very few patients are paying charges for their services and most of the uninsured end up as bad debts.
They allege that there is evidence that hospitals abuse the lax definition for the 340B program. The rules seem very clear and well understood.
They go on to assert that there are no requirements for how hospitals use drugs purchased through the 340B program. Having worked on compliance issues for 340B, I can tell you there are requirements, but that is a longer discussion.
On the site they state that “Lack of oversight of the 340B program has allowed for thousands of instances of noncompliance.” It seems that if this were true, the RACs on ZPICs would be clamping down on the hospitals. The statement itself is a little misleading in that if one or two hospitals had compliance issues considering the volume of drugs under the 340B program we can get to thousands.
Finally comes what I think the real complaint is. They allege that “For-profit chains like CVS have flooded the 340B program.”
I guess it would be no surprise that the membership and board of PHARMA.org is made up almost exclusively by companies like Novartis, Amgen and Pfizer that sell high priced drugs and devices. My question would be, how does a patient benefit if the 340B program is destroyed and patients can’t afford life-saving treatment?
About the Author: Timothy Powell is a nationally recognized expert on regulatory matters including the False Claims Act, Zone Program Integrity Contractor audits and OIG compliance. He is a member of the RACmonitor editorial board.
Contact the Author: tpowell@tpowellcpa.com
The Centers for Medicare & Medicaid Services (CMS) has proposed an episodic payment model, the Transforming Episode Accountability Model (TEAM). This is one of CMS’s
A recent study published in the Journal of the American Medical Association (JAMA) and funded by the National Institute of Neurological Disorders and Stroke (NINDS),
Please log in to your account to comment on this article.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
Copyright © 2024 ICD10monitor. Powered by MedLearn Media.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
