Billing for drugs could become safety issue
A rule implemented Aug. 1 by the Health Care Financing Administration (HCFA) has some pharmacists and other industry insiders concerned about the increased potential for medical errors.
Under the new outpatient prospective pay-ment system, the government will reimburse Medicare services based on the type of procedure performed.
According to Judy Smetzer, RN, director of risk management services for the Institute for Safe Medication Practices in Huntingdon Valley, PA, some medications used in affected procedures will be eligible for "pass-through" reimbursement using HCFA J-codes corresponding with specific drug quantity billing units.
Smetzer says that to use the new billing pro-cess, some pharmacies may need to change their computer billing and inventory systems in a way that could compromise patient safety.
Pat Minard, PharmD, pharmacy manager at Shawnee Mission (KS) Medical Center, says about 300 drugs will be impacted by the new rule, and depending on a pharmacy's computer system, there could be some problems.
For the 300 or so drugs affected, Medicare will reimburse based on specific doses. For example, Medicare will pay for meperidine in 100 mg units. It is produced in units of 25, 50, 75, and 100, and is typically prescribed in units of 50 mg. "But we have to bill them in 100 mg units so we have to charge them for 100, even though we might use 50," he says.
The problem occurs if the patient returns for a refill and the pharmacist or technician reads the bill rather than the prescription, the patient could receive an overdose. In other cases, Minard says there are drugs that Medicare will reimburse in 5 mg doses. "If you prescribe 30 mg, you have to bill them six times," he says.
Smetzer says multiple billing could desensitize nurses and pharmacists to an important error-prevention rule, "always check when more than two or three units are required for each dose."
The new system could create a problem for automatic software pricing and clinical updates as systems are automatically updated through a software system tied to each drug's national drug code (NDC). "If hospitals create new inventory items to match billing units, it may not be possible to load important software updates since the HCFA dosing units will not have an NDC," Smetzer said.
Since adding or changing drug files and the related units of measure may increase the risk of error, Smetzer recommends finding other ways to accommodate the new billing system. "It may be possible to work with your information system vendor to develop rules by which affected drugs will be intercepted between the clinical and financial sides and the units will be converted into compatible units of measure for billing purposes," she says.
For more information, contact:
Judy Smetzer, RN, director of risk management services, Institute for Safe Medication Practices, Huntingdon Valley, PA. Telephone: (215) 947-7797.
Pat Minard, PharmD, pharmacy manager, Shawnee (KS) Mission Medical Center. Telephone: (913) 676-2110.
To read the rule, visit the HCFA Web site at http://www.hcfa.gov.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content