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PBM Aberrant Product Lists: The Aberrant NDC and Percentage Billed Compared to Total Volume is Only Part of the Issue

Beginning in January of 2020, at least one of the major PBMs began monitoring its network pharmacies for the billing of specific NDC numbers the PBM considered “Aberrant”. The list of NDCs was sent to network pharmacies in November of 2019 and has since been updated in November of 2020. The communication states that billing […]

The problem and potential consequences of upcoding

A physician’s duty is to their patient. While this is true, medical professionals have many other responsibilities as well. There are hospital and clinic rules that you must follow. You must adhere to state and national regulations, and you have ethical obligations to uphold. Your medical license comes with strings attached. In your pursuit of […]