Increase revenue by complying with current Medicare waste/charge billing requirements

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Increase revenue by complying with current Medicare waste/charge billing requirements

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My last blog focused on how healthcare IT solutions can streamline dispensing workflow to give pharmacists time to focus on other patient care activities. In this blog, I’d like to provide a look into how an efficient pharmacy application can also increase revenue.

Currently, Medicare offers reimbursement for any unusable, single-use, injectable medication product that is unable to be administered in an outpatient setting. However, the process to receive reimbursement is both cumbersome and time-consuming. It requires the pharmacist or nurse to manually calculate the wasted amount, create a separate waste charge and attach it to the patient’s record with the appropriate JW modifier. J-codes such as JW are alphanumeric codes used in the medical field to report services and non-oral medications that aren’t covered by HCPCS Level I codes. They are used by government payers and commercial insurers to bill Medicare Part B treatments. Recent requirements now also require a JZ modifier to be attached to charges that do not involve waste. This process, if not done accurately, affects general revenue and introduces a missed opportunity to capture previously unrealized reimbursement for wasted products.

Pharmacy can automatically determine if waste is involved in a dosing scenario (or not) and create the separate waste charge or attach the required modifiers to ensure 100% compliance with both revenue scenarios.

With the right solution, organizations can automate this process. Solutions such as Sunrise™ Pharmacy can automatically determine if waste is involved in a dosing scenario (or not) and create the separate waste charge or attach the required modifiers to ensure 100% compliance with both revenue scenarios. This can be accomplished with little or no user impact at the moment of dose preparation, either in the pharmacy or at the patient’s bedside.

Sunrise Pharmacy integrates all workflows and processes related to medication management; we’re working towards the summit of what healthcare should be. If you’d like to learn more about Sunrise and Sunrise Pharmacy, go here.