Under
tremendous pressure to implement the required changes over the next
60 – 90 days, some states already are requiring providers
to submit NDCs for single-source drugs. However, as CMS Director Dennis
G. Smith’s letter to state Medicaid directors noted, “states
have encountered difficulty in linking procedure codes
for multiple source physician-administered drugs to
a single NDC number for the purpose of
billing for rebates, as there may be several NDC numbers
linked to a single HCPCS J-code.”
“Converting generic HCPCS codes (J-codes, S-codes, CPTs) to more
precise NDCs can be challenging—and costly,” commented Gary
A. Loeber, R.Ph., ACM’s Executive Vice President of Business Development. “This
is especially true given the emergence of new specialty
drugs, generics, and shifting sites of care where drugs
are now commonly administered
by healthcare professionals in the home, MD office,
or clinic.”
“The inefficiencies inherent in the HCPCS system also have become
more apparent as the demand for accurate pricing and reporting have exceeded
the system’s capacity,” Loeber added. “For example,
based on ACM’s analysis, paying claims using HCPCS coding can add
as much as $.49 per member per month.”
This area of cost containment is where ACM has been
helping clients generate results for over a decade. Capitalizing
on
ACM’s proprietary
NDC to HCPCS Integrated Crosswalk solution, the MedRxPrecisionSM program
adds automated pricing precision to claims processing, drug edits to
prevent excessive quantities, comprehensive reporting for rebate capture,
and improved administrative efficiencies. As the January 2008 deadline
approaches, ACM’s capabilities can help states meet DRA mandates,
maintain a stable flow of federal funds, and continue
providing essential services to Medicaid beneficiaries.
ABOUT ACM
A healthcare benefits management company, ACM delivers
next generation decision support tools to manage
authorizations, claims processing technology for
pricing precision, nationally-recognized
patient care programs, and first-class provider network
services. Covering over 40 million lives for the
nation’s largest
health plans and payers, Minneapolis-based ACM
is URAC-accredited for health utilization
management and holds full accreditation by EHNAC.
Learn more at www.ACMcentral.com.
Contact: Wendy Capetz, 952-826-2552
