Here Nor There Medicare
The only DX code covered for Hizentra & Hyqvia.
What is G61.81?
The standard Medicare rate.
What is ASP-6%?
Before selecting verification this option should be selected on each referral.
What is ”Start IM Chat”?
Three things on the demo screen that need to be updated.
What is “information complete”, ”place of service”, “USPS address“?
Anti-Tumor Necrosis Factor.
What is S9359?
LCD
What is a Local Coverage Detemination?
For BCBS VA Remicade reimburses at ASP+16%. This would the total reimbursement per 10mg when the ASP fee schedule lists $31.707 (per 10mg).
What is $34.87?
This needs to be uploaded on EVERY specialty drug referral by the intake specialist.
What is a medical policy?
The eligibility check filter needs to be updated to this to confirm pharmacy benefits for Medicare patients.
What is “Part-D Only”?
S9500.
What is ABI Q24?
Provider must be enrolled for Part B covered services.
What is PECOS?
ASP Pricing files are updated.
What is quarterly?
The patients order is unclear on the patient you are working on. This step should be taken to ensure the order information.
What is review/check the medical records for the order?
This needs to be updated in the patients order when a location is utilizing a PBP.
What is the billing provider? (Extra 50 points if you can tell us what the abbreviation stands for).
Per diem utilized for NC Medicaid for Remicade.
What is non-covered? (NC Medicaid only covers per diems for ABI & TPN).
The best way to electronically verify that the patient has a Part-D plan in CareTend.
What is using the Medicare ID?
BCBS GA has specified rates for certain drugs. If the drug is NOT listed this would be the rate used for reimbursement.
What is ASP+6% or 100% of ASP?
The patient has Medicare with no Part-D plan. This is used to quote cash price.
*** DOUBLE JEOPARDY *** What is the SOP cash price listing? Extra 400 points if you can provide cash price amount for S9338.
PBM’s populate incorrectly a majority of the time. Your patient has Tricare and the BIN is 003858. This would be the correct PBM.
What is Express Scripts?
Per diem utilized for SQ IG drugs.
What is S9338? (SQ per diems are not used for IG medications).
Required document needed when billing Medicare for Denial.
What is an ABN? (Extra 50 points if you can tell us what the abbreviation stands for).
Privigen reimburses at ASP+8%. This would be the calculation used to find the correct ASP rate.
What is 8-6=2? (Extra 50 points if you can explain why).
Test claims can be ran 2 separate ways. Both of these MUST utilized and NOTATED on EACH referral.
What is HIT and community retail?
A patient is receiving Glassia 4354mg per week. This would be the correct quantity and day supply needed to receive an accurate test claim response.
What is 5000 quantity for 7 days? (4354 is also an acceptable answer - we can ALWAYS RUN FOR WASTE).
Medicare Patient is receiving TPN. Amino acids 95gm. Lipids and supplies. These would be the required codes for reimbursemen.
What is B4197, B4185, B4224, and B9004?