Medicare Part D claims rejections for nursing home residents, 2006 to 2010.

ABSTRACT:

Objectives

Much has been written about trends in Medicare Part D formulary design and consumers' choice of plans, but little is known about the magnitude of claims rejections or their clinical and administrative implications. Our objective was to study the overall rate at which Part D claims are rejected, whether these rates differ across plans, drugs, and medication classes, and how these rejection rates and reasons have evolved over time.

Study design and methods

We performed descriptive analyses of data on paid and rejected Part D claims submitted by 1 large national longterm care pharmacy from 2006 to 2010. In each of the 5 study years, data included approximately 450,000 Medicare beneficiaries living in long-term care settings with approximately 4 million Part D drug cl

SUBMITTER: Stevenson DG 

PROVIDER: S-EPMC3540110 | biostudies-literature | 2012 Oct

REPOSITORIES: biostudies-literature