Health Care Reform

New Billing and Prescribing Procedures

The business of caring for patients is affected by the new law, and AH can help you to understand how this will affect your 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, 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.

Over-the-counter prescriptions

Effective January 1, 2011, over-the-counter drugs and medicines will 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:

  • acid controllers
  • allergy and sinus
  • antibiotic products
  • anti-diarrheal medications
  • anti-gas
  • anti-itch and insect bite
  • anti-parasitic treatments
  • baby rash ointments/creams
  • cold sore remedies
  • cough, cold and flu
  • digestive aids
  • feminine anti-fungal/anti-itch
  • hemorrhoid treatments
  • laxatives
  • motion sickness
  • pain relief
  • respiratory treatments
  • sleep aids and sedatives
  • stomach remedies

OTC medications and supplies that do not require a prescription:

  • adhesive bandages
  • braces and supports
  • catheters
  • contact lens supplies and solutions
  • contraceptives
  • denture adhesives
  • diagnostic tests and monitors
  • elastic bandages and wraps
  • first aid supplies
  • insulin and diabetic supplies
  • ostomy products
  • reading glasses
  • wheelchairs, walkers, canes