July 1st has come and gone! It is time to review some of the heavy hitters for pharmacy revenue cycle compliance and optimization.
Billing for Waste
Effective July 1, 2023, the JZ modifier is required to attest there was no discarded drug amount from single-dose or single-use containers for all separately payable Part B drugs when billing Medicare beneficiaries. The JW modifier continues to be required to report discarded drug amounts in addition to clear documentation of the discarded drug amount in the medical record. Each separately payable, single-dose or single-use container should have either a JW or JZ modifier reported on the claim. The Medicare Claims Processing Manual (Ch-17, Sec 40) has been updated and Medicare Administrative Contractors (MAC) have published Coverage Articles that provide additional guidance. Additionally, CMS published an FAQ to help providers effectively implement the waste policy.
It is important for organizations to audit their process and validate their compliance. Effective October 1, 2023, CMS may return claims to providers as un-processable until each claim has the appropriate modifiers reported. Please reference our earlier newsletter for more details Pharmacy Revenue Cycle: Drug Waste.
The trend of new drugs to the market and designer HCPCS continues to evolve. The Visante Quarterly Update Tool is designed to help organizations understand how to evaluate the CMS quarterly files and stay on top of the quarterly updates.
As new drugs continue to come to market, the Visante C9399 Tool has been updated through July 2023. Visante continues to stay on top of the market and monitors for each drug to publish this one-of-a-kind curated list.
- Pharmacy and Revenue Integrity Teams should conduct self-audits on internal processes to validate the modifiers JW and JZ are appropriately attached.
- Reach out for help! The Visante Pharmacy Revenue Cycle team is prepared to help you conduct quick audits of your system and validate you are up to date!
Our goal is simple; we’re taking complex information and making it practical. Until our next edition, this is Visante Pharmacy Revenue Cycle providing you with tips for increasing your Pharmacy Revenue.