Specialty Pharmacy Billing

[lcbrown76]

Hello, I recently started working for a pharmacy and I noticed that we bill Medicare and Medicaid under one tax id (specialty Pharmacy) and bill commercial under the perscribing dr tax id.  Is this legal?  All of the drugs are being shipped by the same specialty pharmacy.

[Michele]

I am not familiar with Pharmacy but as I read your question it doesn't make sense to me.  If they bill under the prescribing dr tax id wouldn't the payments be messed up?  But if they've been doing it that way for any amount of time they would know that.  I'm not sure but I'm curious to know.   

[lcbrown76]

The payments go to different lockboxes. I just think something is not right because we when call to verify benefits we verify under the dr to "get around" the pharmacy benefit. So the member does not have to go to Express Scripts etc. All of the drugs come from the same place so why would billing be different. I wish I knew what was right as I don't want to be doing anything illegal or fraudulant.

[Michele]

I'm not sure how you can check.  I'm not familiar with pharmacy billing at all.  Anybody else??