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Pharmacy Revenue Cycle NewsEpisodes
Episodes of Pharmacy Revenue Cycle News
Mark All
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CMS has proposed that non-disable, under age 65 year old kidney transplants have lifetime coverage under Part B for immunosuppressives instead of the 36-month limit currently.
Whoa! IPPS Proposed Rule includes new process that drugs for NTAP be reported with an NDC number rather than an ICD-10-PCS code. Can your IT system handle this change so you don't lose revenue?
Why would an IVPB charge be denied by a payer? In some cases the payer is incorrectly denying the charge. The denial should be clarified and challenged when appropriate.
Billing for ESAs on outpatients requires special modifiers and may include laboratory values.
The Integrated Outpatient Code Editor (I/OCE) is a useful quarterly update to help in producing a reimbursable claim.
Two new HCPCS code and one new product bring the total to six products classified as Car T-cell therapy.
Denied Claims should be reviewed but if the billing is correctly and the service is medically necessary, an appeal is warranted.
CMS has established a HCPCS code for reimbursement when outpatients receive convalescent plasma.
Timing of Dose Administration may lead to claims denials for Pegfilgrastim
When do you issue an ABN and when is it prohibited?
Aduhelm and proposed NCD For Medicare requires a qualifying clinical trial for coverage.
Important information about a new HCPCS code for Remdesivir
Important Dose change with new HCPCS code for Pegfilgrastim
What to do what the actual reimbursement is less that expected. Is it sequestration?
Pharmacy is in a unique position to help with Pharmacy Revenue Cycle when Quarterly Restated Payment Rates are significant.
Have you checked for new HCPCS codes, MUE values, and ASP Prices yet?
Everything's made up and the points don't matter. The points are like setting hospital drug charges.
Setting hospital drug prices can be complex or simple, but there are basic factors to be considered.
Dietary Supplements and Herbal Products aren’t drugs and can’t be billed as if they were.
Critical Access Hospitals have different rules and different reimbursement from Part A and Part B.
Some things appear to be drugs but are devices and vice versa. How does this impact revenue?
Only certain providers can use C Codes to bill Part B claims to Medicare.
Only certain NDC numbers are eligible for coverage and payment under State Medicaid Programs. CMS has a database where the NDC number can be verified.
Influenza, Pneumonia and Hepatitis B vaccine for high risk patients are covered under Part B regardless of provider location.
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