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If following review of the request and the supporting documentation, the MAC agrees that there likely would be significant recoupment of the hospital's interim Medicare uncompensated care payments at cost report settlement, the only change that will be made is to lower the per discharge amount either to the amount requested by the hospital or another amount determined by the MAC to be appropriate to reduce the likelihood of a substantial recoupment at cost report settlement

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The inactive ingredients are: water, glycerin, distearyldimonim chloride, petrolatum, isopropyl palmitate, cetyl alcohol, avena sativa, kernel flour, benzyl alcohol, sodium chloride, allantoin, citric acid

5 ounce size for a 30 days supply