HCPC Crossover
In the current healthcare environment, it is critically important to ensure that all opportunities for enhanced revenue are captured. Hospital OPPS is an area where many hospitals have opportunities to improve revenue. Medications that are eligible for additional pass-through payment are often missing HCPCS codes, have an incorrect HCPCS code and/or are using the wrong billing multiplier. HCPC Crossover can address these issues.
Pharmacy Charge Master Issues:
- Complexity of billing and coding medications for Medicare OPPS payment.
- Requires joint effort between pharmacy and finance.
- Time-consuming for pharmacy and billing to ensure charge master is complete, accurate and maintained quarterly in accordance with the quarterly Medicare billing updates.
- Formulary "scrubbing" tool that ensures pharmacy formularies are built to bill Medicare with the proper HCPC codes and billing units.
- The tool that will ensure that the formulary and charge description master are updated appropriately to ensure proper billing for drugs.
Two Step Process:
- The pharmacy's formulary is submitted to FusionRx in an Excel, ASC or text file. The formulary is scrubbed by HCPC Crossover. All items eligible for pass-through payment are noted and any items requiring updates to the HCPCS code and/or billing multiplier are highlighted.
- An e-mail is sent out each quarter to each client hospital after CMS issues the quarterly updates for OPPS to request the pharmacy's formulary file. HCPC Crossover will review the formulary to determine changes based on the quarterly updates and new formulary additions.
Additional Service:
If a utilization file is submitted, FusionRx can determine the net
revenue impact of the changes.
Return on Investment:
The average annual return on investment is $150,000.
The range has been $100,000 to $350,000.
