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Mastering short-cycle rules can be challenging and confusing. Coding practices can negatively impact your reimbursements if not followed according to Centers for Medicare and Medicaid Services (CMS) short-cycling guidelines. To help avoid the headaches that may accompany common pitfalls, like under-reimbursements due to improper coding, it is important to identify the issues and have the knowledge to remediate them to maximize reimbursements and prevent audits. In this article, you will learn the basics of appropriate coding, how to identify exceptions to short-cycling rules, and how coding ensures transparent communication with the plan.

Pharmacy managers are faced with managing the delicate balancing act between collecting maximum reimbursements from third-party payers and offering competitive drug pricing to patients who do not have insurance. There are several factors that pharmacies can consider when determining their Usual and Customary pricing strategy.

Understanding the different DAW codes and how to apply them appropriately is an important first step in pharmacy billing. Download the DAW Code Reference Chart in this article and learn what they are, how they affect claim adjudication, the impact to your bottom line and technology solutions that can identify potential errors or missed opportunities.

Split billing can introduce many subtle but complex scenarios that can result in reimbursement issues and delays. The extra time to process and complicated coding (such as other coverage codes) impact the pharmacy workflow and reimbursement.

When it comes to optimizing prescription claim billing with third party payers and PBMs, effective use of both pre edit and post edit solutions can improve pharmacy revenue. This article discusses the benefits of each solution and how having both can help create a win-win by protecting the revenue you already earned and opening time for your team to grow the business.

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