Wiki How to figure out the correct charges for injections

[smeadows177@comcast.net]

I am needing some guidance on figuring the correct amount to charge on injectable drugs. The previous biller never billed for any injections that were given at the office I am currently working in. I am trying to bill for an injection of toradol and in my software the code was never added along with the amounts. I have looked at the fee schedule on my MAC website (cahaba) and the CMS web-site but am very confused on how to figure the amount that can be billed. Any advice or guidance would be greatly appreciated. (The patient has BCBS actually so do I need to look there for pricing?)

 

[mhstrauss]

I am needing some guidance on figuring the correct amount to charge on injectable drugs. The previous biller never billed for any injections that were given at the office I am currently working in. I am trying to bill for an injection of toradol and in my software the code was never added along with the amounts. I have looked at the fee schedule on my MAC website (cahaba) and the CMS web-site but am very confused on how to figure the amount that can be billed. Any advice or guidance would be greatly appreciated. (The patient has BCBS actually so do I need to look there for pricing?)

I recommend (and I've seen others post similar advice) gathering the info on all the drugs your clinic injects/administers--the amount you pay, the fees each payer pays, etc. Set your fee at a certain percentage above invoice cost, for example 50%, and see if that puts your fees above the fee for all of your payers. If yes, you're at a good point. If not, go higher. But this will allow you to be consistent across the board. Will just need to compare your cost on a regular basis to make sure your fees keep up with drug cost increases.

Hope that helps!

 

[smeadows177@comcast.net]

Thank you. That does help to give me a jumping off point.