tci Medicare Compliance & Reimbursement - 2005 Issue 2

PHYSICIANS: Least Costly Alternative' Could Cost Docs A Bundle

And 'pool leakage' soaks surgeons for $60 million. Some carriers are going haywire with overzealous implementation of an obscure Medicare requirement to pay only for the cheapest drugs.Medicare requires carriers to pay for the "least costly alternative" for drugs. This doesn't mean doctors have to provide the cheapest drug for a particular condition, but it does mean that if you provide a more expensive drug, the carriers will only pay you for the cheaper alternative.Some carriers are applying this rule in instances where it makes no sense, providers complained to the Practicing Physicians Advisory Council's Nov. 22...

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