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Pharmacy Billing: Keys to Staying Within MUE Limits Pharmacy MUE Value Sheet How to Avoid the Big Four Payment and Compliance Risks for Hospital Pharmacies: Discarded Drug Billing
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Thursday, August 13

Have you heard about the case of the missing drug payment? Or maybe your hospital has experienced it. A prime suspect: medically unlikely edits (MUEs).

Identify and correct billing errors before denials occur

You may know the acronyms MUEs, MAIs and MAUs. But do you understand the extent to which they result in Medicare claim denials for pharmaceuticals?

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Does your pharmacy personnel know if multi-use vials are subject to payment for discarded amounts of the drug or biological? Do they know when your facility might be required the use of modifier JW? These deceptively simple questions if answered incorrectly could put your facility at compliance risk and under the scrutiny of the OIG and CMS. Join us as we carefully navigate the potential areas of compliance and revenue.

How to Avoid the Big Four Payment and Compliance Risks for Hospital Pharmacies: Coding and Billing How to Avoid the Big Four Payment and Compliance Risks for Hospital Pharmacies: Provider-Based Clinics and 340B Compliance How to Avoid the Big Four Payment and Compliance Risks for Hospital Pharmacies: Compound Drugs
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In both the physician office and hospital outpatient setting, infusible drug amounts are billed on the claim form as "units." For established drugs (those having a drug specific HCPCS code) the number of units is determined by the HCPCS descriptor for the drug being billed. The OIG and RAC auditors continue to examine claims for billing errors. Compliance with these complicated billing requirements is a never-ending issue that providers must monitor to ensure correct revenue and avoid investigations.

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Your facility could be at risk by sharing provider-based space with freestanding clinics, especially if your hospital participates in the 340B drug-discount program. You can almost feel the heat because failure to meet these requirements will put your facility under scrutiny by CMS or the OIG. 340B noncompliance puts your hospital at risk of losing the payment differential over what freestanding clinics get for the same services. Without information from this webcast, audits and even the future of the supplemental reimbursement hangs in the balance.

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The 2015 fiscal year (FY) OIG Work Plan notes that the OIG will determine the extent of Medicare's oversight regarding how Medicare-participating acute care hospitals address their recommended practices for pharmaceutical compounding. The OIG considers this to be particularly important in view of a 2012 meningitis outbreak, resulting from contaminated injections of compounded drugs.