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Pro Pharma Announces JCode Calculator™ 3Q-2014 Pricing Update
This “Pricing Tool” is for claims and billing professionals and provides improved efficiencies with an up-to-date Crosswalk Tool which saves resources, time and money.
“Pro Pharma’s JCode Calculator™ (Standardized Crosswalk Tool) is a ‘must have’ desktop resource, and is a Tool that is totally unique in the industry with Unit Pricing Based on HCPCS Descriptions”, states Dr. Craig S. Stern, President of Pro Pharma Pharmaceutical Consultants, Inc. “In not using a tool like JCode Calculator™, Coders and Billers may place their organizations and employers in a position to potentially face audits, penalties and payment delays from both Medicare (CMS) and Medicaid if billing is not performed accurately,”
The primary benefits of Pro Pharma’s JCode Calculator™ are as follows from Dr. Craig Stern’s comments above:
- Decreased costs with increased efficiencies
- Avoidance of having to face potential audits from both Medicare and Medicaid, including penalties and potential fines due to not billing accurately/appropriately.
- Elimination of chaos on the backend of potential billing rejections, etc.
Pro Pharma’s JCode Calculator™ provides an invaluable resource to ensure standardization of reimbursement procedures to providers which results in overall savings to the organization due to consistent billing and reimbursement practices. Additionally, this Standardized Tool provides information to avoid “upcoding”
“The JCode Calculator™(http://propharmaconsultants.com/
Please visit Pro Pharma Consultants website for complete information.
About Pro Pharma Pharmaceutical Consultants, Inc.
PRO PHARMAis a multi-service, woman owned, privately held consulting firm offering a vast portfolio of services to public and private entities including self-insured employers, Taft Hartley Trusts and unions, public employers, for-profit hospitals and integrated health networks, health care insurance companies, worker's compensation insurers, small-to-medium sized HMO's, and physician groups.
As a primary service to plan sponsors for achieving below trend results, PRO PHARMA provides an integrated program of administrative process improvements, clinical quality oversight, and provider/member education.
Pro Pharma’s Consulting services are grounded in the use of data and the communication of that information to define benefit trends, drivers and other analytical indicators. PRO PHARMA markets Biotech Modeling™, Invoice Screening ™, JCode Calculator™, Quality Management Program™, Rx MAC List™, Treatment Calendar™, and Pro Pharma Suite of Tools™. The Company directly markets its products in the U.S. and collaborates with partners to reach international markets.
About Quality Management Program™ (QMP)
Pro Pharma’s Quality Management Program™ (QMP) is a multi-faceted approach that targets the pharmacy benefit cost and quality from multiple directions; namely, physician prescribing decisions, member demands, pharmacy oversight and patient education, HR rep education, and messaging to actives/retirees. The program is focused on providing patients and physicians specific tools designed to make more informed purchasing decisions that expand member co-pay dollars. The bottom line is: payers (self-insured, employers, Trusts, etc.) lower their pharmacy trend.
About Invoice Screening™
About 10% of drugs spend is being paid from PBM Invoices, and should have been rejected by clients prior to payment. Pro Pharma’s Invoice Screening™ analyzes invoices against: formulary compliance, compliance with MAC pricing, eligibility, claims pricing, invalid claims, and excluded benefits, pre-payment as an Accounts Payable function. This ensures that clients only pay for valid claims, which saves time and dollars in the long run.
About Treatment Calendar™
Pro Pharma’s Treatment Calendar™ is a proprietary program comprised of Artificial Intelligence rule sets, which allow for quality and cost comparisons by peer-to peer, peer-to-best in class, peer to national norms, and peer to local norms.
Pro Pharma uses Clinical Protocols to analyze patient encounter data and diagnoses for required exams, tests, and medications. In this way, physician practices can schedule the applicable services for each patient and then review them for exceptions.
Treatment Calendar™ functions in the following manner as a:
- Quality tool for benchmarking
- Tool to align provider and payer incentives by focusing on actionable patient specific quality improvements
- Risk management tool to identify therapy that doesn't comply with national norms
- Tool to graphically identify gaps in compliance
About Rx MAC List™ (Pharmacy Maximum Allowable Cost™)
The Cost of Drugs is Skyrocketing. Pro Pharma develops and maintains customized MAC Lists for clients to help manage the effects of rapid and high increase of drug prices.
About Pro Pharma Suite of Tools™
Pro Pharma’s Suite of Tools identifies the cost and clinical issues for both Pharmacy and Medical, and formulates management plans and objectives to develop action plans to address “prescriptions for change”.
Please visit Pro Pharma Pharmaceutical Consultants, Inc. website for more complete information.
Carol Stern, CEO