“Teach a man to fish, and you’ve fed him for a lifetime” is a popular quote. Pharmacy Revenue Cycle News reviewed the July 1, 2021 updates for you, and now has published a new tool for your organization to breakdown the quarterly updates published by CMS. The tool can be found here or go to pharmacyrevenuecycle.com > Resource Files > Tools.
The Quarterly Update Tool highlights where the information is located that will be published by CMS, followed by a column “Action to Take” that describes how and what to evaluate with each published file. CMS publishes this information and files sporadically; thus, the checklist serves as a tool for users to understand who and when the files were reviewed and acted upon.
Recall CMS updates HCPCS codes on a calendar quarterly basis. All changes should be updated in the electronic health record by the start of the quarter, also known as the effective date: January 1, April 1, July 1, and October 1.
Shout Outs! Pharmacy and Revenue Integrity Teams collaborate to designate a point person(s) that can help monitor for updates and coordinate changes in the health record by the effective date. The Quarterly Update Tool is here to help!
Pharmacy and Revenue Integrity Teams take note of the October 1, 2021 update. There are several new codes that are replacing the discontinued codes. Ensure you map these drugs correctly to add the new codes and billed units and remove the discontinued codes.
Pharmacy and Revenue Integrity Teams ensure you carefully evaluate for changes in billed units, such as, J0699 Injection, cefiderocol, 10 mg is added while J0693 Injection, cefiderocol, 5 mg is being removed.