Pharmacy Analysis

Indexing NDC, CPT/HCPCS and bill units from your formulary, this report determines the appropriate bill units for each NDC and CPT/HCPCS combination, and compares them to reported bill units. The base report puts out a True/False flag indicating if there is a variance between client bill units and our calculated units.

One of the most useful reports we make available: Cost-to-Charge calculates the variance amount and percent of variance between the cost and charge/price fields. The report also can be filtered and sorted as needed.

This report creates a comprehensive listing of line items that have valid NDC and CPT/HCPCS code combinations. Additional NDC specific columns are also available for users when selected. The ‘ASP Allowable’ tab amounts are calculated using the ASP pricing plus 6% times the billable units for the specific NDC and CPT/HCPCS code combination. The variance and the variance-percentage are then calculated using the charge amount listed in the file, and the APC payment amount.

This report creates a list of line items in the file that have a valid NDC and CPT/HCPCS code combination in our best practice suggestions listing. It includes displayed columns for Average Sales Price (ASP), Average Wholesale Price (AWP), and Status Indicators for each valid combination. Additional NDC specific columns you require can be displayed when selected.

With this report, a list of line items that are missing or have an improper CPT/HCPCS code combination for the NDC on the line item(s) is displayed. Clicking on the CDM charge code, CPT/HCPCS code, or on the NDC on the line item will open the lower panel to display the ‘Suggested codes’ and ‘NDC’ tabs. These will display the CPT/HCPCS codes that are associated with the NDC. As you might imagine, this is a highly useful, major time-saving report.

This report lists line items that are missing a CPT/HCPCS code associated with the NDC and/or have a CPT/HCPCS combination that does not match Vitalware’s best practice suggestions for revenue code assignment. In the bottom panel, the ‘Suggested Codes’ tab will list the revenue codes and CPT/HCPCS that are associated with the NDC. When exported, a separate tab is generated as ‘Suggested Rev Codes’ that serves as a companion document.

You’ll get a full listing of line items and their descriptions that have a valid NDC code. This report will also include the NDC description as well as the CPT/HCPCS code and description. Clicking the CPT/HCPCS Code or the NDC Code opens a bottom panel and an associated ‘Code Detail’ tab. This report can be used to compare the CPT/HCPCS and NDC descriptions to your file description for inconsistencies. Additionally, there is a ‘Columns Available’ option, which provides the NDC data set information including: Labeler Name, ASP Price, Package Size, bill units, Bill Package, SD/MD per each, SD/MD per-package, and Route of Administration (ROA). All of these are available to display within the solution grid.

This output identifies and lists NDC codes that are not included in Vitalware’s VitalKnowledge database. To address these items, we always suggest that users review NDC formats to ensure that labeler and other drug specific details are accurate – for example, including leading 0’s if required. In some cases, these codes will be ad-hoc instances, and can be recoded or deleted as necessary.

Gathers all items containing deleted/expired NDC codes. These line items will have a deleted/expired NDC code as compared to Vitalware’s VitalKnowledge database.