Fast, Easy Access to Medicare HCPCS Drug Information
First DataBank's Medicare Module - HCPCS Select™ speeds up and simplifies billing, processing, and auditing of Medicare reimbursement claims—including Part B. Significant time and expense savings typically follow from improvements in formulary building, billing, coding, claims processing, and auditing. The module can help you quickly and accurately resolve drug-product claims issues by providing an easily integrated electronic drug database that includes essential Medicare drug data.
Integrated Content Allows for Quick Claims Processing
Each week, millions of Medicare claims for drug products are processed nationwide. As more people turn 65—and as patients and providers become more familiar with Medicare Part D—those numbers will increase dramatically.
But even without this expected increase, today there are many instances of coding errors, rejected claims, and slow reimbursement. The main reason is simple: Healthcare Common Procedure Coding System (HCPCS) content from the Centers for Medicare & Medicaid Services (CMS) is not formatted for automatic integration into provider and private payer systems which are essential for efficient claims filing and processing.
Comprehensive Medicare Drug Information Meets Your Every Need
Once integrated into your system, our Medicare drug database—for which updates are sent as frequently as weekly—allows quick access to information on drugs with HCPCS codes for use in the Medicare system, as well as non-covered drugs that can be reported in other settings. This information includes"
- Appropriate HCPCS codes for an NDC
- Short HCPCS code descriptions and their coverage status
- Current and historical Part B payment allowance limits by HCPCS code
- Current and historical NOC (Not Otherwise Classified) payment limits by NDC code
- The date upon which the HCPCS code became valid for reporting
We provide the coverage status for drug products associated to HCPCS codes, indicating when they are not covered by Medicare, covered with special instructions, covered at the discretion of carriers, and when coverage information is not available.
Useful Price Types Facilitate Billing
The Medicare Module - HCPCS Select also includes a separate Medicare Part B table for drugs used during physician and outpatient services. The table includes both current and historical payment allowance limits for these drugs, as published by CMS.
ASingle Integrated Source for Medicare Information Simplifies Processing
Many of the data-handling problems that Medicare participants encounter are eliminated by our integration of multiple sources and standalone lists. By integrating these additional sources into our Medicare drug database, First DataBank fills several gaps in the Medicare information space, creating numerous advantages:
- Our databases allow users to link HCPCS Codes to NDCs, and to connect HCPCS information with pricing data, enhancing information processing.
- HCPCS content cannot be integrated into Medicare providers’ and payers’ healthcare information systems automatically. By integrating these codes and pricing data, we make Medicare claims filing and processing seamless.
- Both providers and private payers need a reference for viewing Medicare Part B pricing data—the payment limit set by CMS—to determine reimbursement levels.
All of these features make our Medicare Module — HCPCS Select a reliable and convenient electronic reference available to support sound Medicare drug pricing decisions.