We began using the J-codes and multipliers in BAR on 8/1/06. I'm a
pharmacist, so I don't know a whole lot about BAR. I had billing print out
all of the claims for our outpatient oncology center from August and noticed
that the J-code was showing up on UB92 forms for medicare patients
correctly. However, when a 1500 claim form was used for private insurers
(Optimum Choice for instance), the J-code printed out, but the quantity was
only what passed through from the pharmacy billing log (it didn't multiply
this x's the multiplier). The billing people swore that this was not an
issue. However, I was then asked this week why we were only being reimbursed
$79 for a $5,000 plus chemo drug. I said that it looked like they only paid
for 1 J-code unit which was what was on the claim. My analyst can't figure
out how to get the multiplier to work on a 1500 claim form. Does anyone have
any idea how to accomplish this?
Thanks,
Charlie
Charles Downs Pharm.D.
Washington County Hospital
Inpatient Pharmacy
251 E. Antietam Street
Hagerstown, MD, 21740
301-790-8904
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