Georgia Medical Bill Reviewer Training Program

1. Georgia Medical Bill Reviewer Training Program Unit 3: Pharmacy and Supplies Module 1: Pharmacy Guidelines

2. Hi! In this module, you will learn about pharmacy guidelines. Then, you will learn how other types of pharmacy services are reimbursed. Overview • Pharmacy Reimbursements • Supplies

3. Key all pharmacy charges as billed. The National Drug Codes (NDCs) are available in the system. If the NDC code is not found in the fee schedule, payment will recommended at the usual and customary value (at the applicable percentile), or will be recommended for payment at the providers billed charge, whichever is less. Pharmacy Guidelines

4. Prescriptions require a few pieces of information that you can locate on a pharmacy bill. The required information is: Prescription Reimbursement • NDC number • Number of units • Billed Charge • Date of Service

5. Key all pharmacy charges as billed. The National Drug Codes (NDCs) are available in the system. • If the NDC code is not found, payment will be the lesser of the following: • U & C value at 110% • Billed charge Pharmacy Guidelines

6. Supplies and/or materials normally necessary to perform a service (for dates of service on and after 07/11/07) are paid for DME services according to Medicaid’s DME fee schedule. • These include supplies such as: • Cotton balls • Band-Aids • Applied meds/ointments Drugs and Supplies

7. Supplies and materials provided by the physician over and above those usually included with the office visit or other service rendered may be charged for separately. The recommend payment must not exceed the invoice cost of the item, applicable taxes and any shipping and handling costs associated with delivery from the supplier of the item to the physician’s office. Bill using CPT code 99070. Key as billed. There should be no additional "handling" costs added to the total cost of the item. Drugs and Supplies

8. Pharmacy Reimbursement Guidelines Summary Reimbursement of Supplies That’s All, Folks!!!