White Bagging: Emerging Trends, Provider Response, and Implications for Reimbursement
Course Details
- smart_display Format
On-Demand
- signal_cellular_alt Difficulty Level
- work Practice Area
Health
- event Date
Tuesday, February 21, 2023
- schedule Time
1:00 p.m. ET./10:00 a.m. PT
- timer Program Length
90 minutes
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This 90-minute webinar is eligible in most states for 1.5 CLE credits.
This CLE webinar will guide healthcare counsel on white bagging and how different healthcare providers are responding to white bagging mandates. The panel will address white bagging in the litigation context and discuss how white bagging impacts regulatory compliance.
Mr. Dresser heads the firm’s Pharmacy Practice Group. In this role, his practice is dedicated to representing a broad cross-section of pharmacies and pharmacy providers, including community retail pharmacies, chain pharmacies, compounding pharmacies, specialty pharmacies, mail order pharmacies, home infusion providers, digital pharmacies, and dispensing physician practices. Mr. Dresser represents pharmacy providers nationally regarding issues with payors and Pharmacy Benefit Managers (PBMs), including PBM audit appeals, network terminations, network access and credentialing applications, and reimbursement issues.
Ms. Gordon’s practice centers on managed care litigation in counseling providers, hospital systems, and device manufacturers in disputes over benefit determination, medical necessity denials, contract interpretation, and in- and out-of-network reimbursement. With over 15 years of litigation experience, she is well-versed in providing tailored strategic solutions to represent clients in the ever-changing landscape of healthcare litigation. Ms. Gordon’s representative work includes resolving disputes between healthcare companies and health plans regarding coverage and reimbursement disputes. She has noteworthy experience representing hospital systems and medical device manufacturers in disputes regarding underpayments and denials due to medical necessity, experimental/investigational designations, recoupments/offsets, DRG downgrades, billing and coding audits, including not-separately reimbursable line-item charge denials, as well as unilateral payor policies involving E/M downcoding, Sepsis-3, white-bagging, Covid-19 reimbursement, site-of-service coverage, and other policies resulting in a reduction of reimbursement and an increase in administrative burden.
White bagging is a practice involving healthcare providers (such as doctors, clinics, and hospitals) and pharmacies, whereby a patient's medication to be used in a procedure is sent directly by the pharmacy to the provider at which the patient is receiving care. Many payers, primarily large national insurers, have recently begun to mandate white bagging by requiring that in-office administered medications be purchased and dispensed through the payers’ pharmacies, as opposed to being sourced and provided by the administering provider. Healthcare providers are then expected to receive and administer this medication filled and dispensed by the payer-owned pharmacy.
While payers have suggested that white bagging helps control costs based on the site of care, it also bypasses many of the healthcare system’s checks and balances, such as pharmacy formularies, checking of drug interactions, and safety protocols. This practice also puts at risk medication and supply chain integrity, as well as patient safety.
As insurers are implementing mandatory white bagging policies for certain medications, healthcare systems and providers must prepare to address the issues created by these policies. Further, they need to be ready to address these concerns in both regulatory compliance and litigation.
Listen as our authoritative panel of healthcare attorneys examines white bagging and how different healthcare providers respond to white bagging policies. The panel will also address white bagging in the litigation context--both how the courts address the issues and litigation strategies. The panel will discuss how white bagging impacts contract negotiations.
- White bagging
- Healthcare provider response
- Court treatment and litigation strategies
- Implications for contract negotiations
The panel will review these and other material questions:
- What impact do white bagging policies have on the provider's ability to seek reimbursement for these medications?
- What measures should healthcare providers take to mitigate the risks created by mandatory white bagging?
- What can providers do to ensure indemnification for accepting white-bagged medications?
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