“APC” billing units can be generated automatically for targeted HCFA drugs

With previous versions of Ascend-IP, users had to create a formulary item to match the allowable billing unit for any HCFA “APC” drugs they were using. For example, if “NEWDRUG INJ” is to be charged in "10MG" APC billing increments, the pharmacy had to have “NEWDRUG INJ 10MG” in their formulary with a charge code/price for the 10mg billing increment. To charge for "50mg" doses, the user had to edit the order ingredient’s quantity/dose box to contain "5" (i.e., 5 x 10mg = 50mg dose) in order to charge correctly.  

The new version supports the new Billing Multiplier field in the formulary. If the “billing multiplier” value is greater than “1”, the Ascend-IP program will multiply the quantity/dose field value for this ingredient by its “billing multiplier” value to determine the true billing quantity to charge for. In the following table, the first example uses the old method, whereas the last 3 use the new “billing multiplier” field:

* The ingredient quantity/dose can be automatically calculated if the user edits the Dose field in the order. 

**The billed quantity will be rounded up from 2.5 to 3 when transmitted to the hospital financial system.

Using “billing multipliers” for APC drugs also makes it easier to dispense these drugs from ADS units (e.g., Pyxis, etc.). ADS units always send Ascend-IP whole charge quantities. For example, if Pyxis sends a charge code for “NEWDRUG 50 MG INJ” with a quantity used of  “1”, Ascend could transmit a quantity of “5” to the hospital system (i.e., qty 1 x 5 billing units = 5) rather than “1” as it would have with the older version. Therefore, if “billing multipliers” are used, pharmacy no longer needs to exclude APC drugs from being dispensed/charged via ADS units or manually handle such charges. 

If the billing muliplier field is to be used for an item, be sure the formulary record for the item follows these rules:

1. Be sure to make all entries using consistent units of measure.

2. The item description can represent a commercially available inventory size, even if it is much greater than the HCFA allowed billing unit amount for this drug.

3. The “dose” and/or "per" values in the formulary record must equal the amount represented by the entire inventory item.

4. The charge code number (a.k.a., CDM) must represent a charge for the “HCFA allowed billing amount” (which is typically much less than a charge for the amount in the item’s description or dose fields)

5. If the “billing multiplier” is NOT to be used to calculate the billing quantity, this field should be left blank, or contain a “1”. Otherwise, the “billing multiplier” value times the “HCFA allowed billing amount” must equal the “dose” value (i.e., the “amount” represented in the item description or dosage fields). Alternatively, the “billing multiplier” value should equal “Dose” divided by “HCFA allowed billing amount”.  

Example: If "EPOGEN 4000 UNITS" is the inventory item and the HCFA allowed billing amount is 1000 units, the drug description should be "EPOGEN"; the charge code/CDM should be a number representing the billable amount (1000 units); the "Dose" field should be "4000" and the "Billling Multiplier" should be "4". The test: “billing multiplier” value (4) times the “HCFA allowed billing amount” (1000) must equal the “dose” value (4000).