Recovery audit contractors have been identifying errors in drug dosages that lead to overbilling, according to a report by the American Society of Health System Pharmacists.
During the RAC demonstration project, CMS cited overpayments for "excessive units" of the drug pegfilgrastim as an obvious error targeted by the RACs. This error could occur, for example, when six units of the drug instead of one 6-mg unit were billed.
Similarly, in the full implementation of the program last year, RACs in some regions were examining claims for drugs like cetuximab, carboplatin, and bevacizumab when the vial size did not match the billing unit.
In another example, a RAC audit at Twin Lakes Regional Medical Center in Leitchfield, Ky., revealed overbilling for oxaliplatin. Hospital officials said when the drug was entered into the pharmacy computer system based on package size, the system applied a "charge multiplier" to convert the amount of drug used into billable units.
The Twin Lakes computer system counted dosages in 100-mg units, so if the pharmacy dispensed 180 mg, the system was charging for 200 mg, or two full vials. The hospital fixed the problem by modifying the computer system so that drug quantities are entered in billable units, not by full vials. However, Twin Lakes officials were not sure if this solution met CMS' expectations for minimizing wastage of drugs in single-use vials.
Read the American Society of Health System Pharmacists report on RACs.
Read more coverage of RACs:
- Region A RAC Sending Demand Letters on Therapy Untimed Codes
- 10 Tips on Improving RAC Readiness From Kaiser's RAC Expert
- 18 Findings from the Latest AHA Survey on RAC Activity
During the RAC demonstration project, CMS cited overpayments for "excessive units" of the drug pegfilgrastim as an obvious error targeted by the RACs. This error could occur, for example, when six units of the drug instead of one 6-mg unit were billed.
Similarly, in the full implementation of the program last year, RACs in some regions were examining claims for drugs like cetuximab, carboplatin, and bevacizumab when the vial size did not match the billing unit.
In another example, a RAC audit at Twin Lakes Regional Medical Center in Leitchfield, Ky., revealed overbilling for oxaliplatin. Hospital officials said when the drug was entered into the pharmacy computer system based on package size, the system applied a "charge multiplier" to convert the amount of drug used into billable units.
The Twin Lakes computer system counted dosages in 100-mg units, so if the pharmacy dispensed 180 mg, the system was charging for 200 mg, or two full vials. The hospital fixed the problem by modifying the computer system so that drug quantities are entered in billable units, not by full vials. However, Twin Lakes officials were not sure if this solution met CMS' expectations for minimizing wastage of drugs in single-use vials.
Read the American Society of Health System Pharmacists report on RACs.
Read more coverage of RACs:
- Region A RAC Sending Demand Letters on Therapy Untimed Codes
- 10 Tips on Improving RAC Readiness From Kaiser's RAC Expert
- 18 Findings from the Latest AHA Survey on RAC Activity