MINNEAPOLIS, Sept. 24 /PRNewswire/ -- When the Deficit Reduction Act of 2005 (DRA) goes into full effect January 1, 2008, state Medicaid programs must demonstrate compliance with the requirement to collect National Drug Codes (NDCs) on physician-administered drugs or risk losing federal funding.
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 MedRxPrecision(SM) 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.
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.
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