Revenue Rx

Lubna Mazin
  • 5.0 (6)
  • Business
  • Updated Weekly

Revenue Rx is a podcast at the intersection of pharmacy and finance, designed to simplify the complexities of pharmacy revenue cycle management. Hosted by Lubna Mazin, PharmD, MS, 340B ACE a pharmacy leader with experience across health system operations, specialty pharmacy, and revenue cycle strategy, this podcast breaks down the systems that drive reimbursement, margin, and patient access. From drug pricing and payer dynamics to CMS updates and high-cost therapies, each episode translates real-world challenges into practical insights you can actually use. Whether you are new to pharmacy revenue cycle or deep in the work, Revenue Rx is your space to connect the dots, build confidence, and stay ahead in a rapidly evolving landscape. Healing patients is the mission. Protecting the margin is the strategy. This is Revenue Rx.

  1. 4d ago

    The Rosetta Stone of Pharmacy Billing

    In this episode of Revenue RX, we discuss why the NDC/HCPCS crosswalk serves as the "Rosetta Stone" of pharmacy billing, translating the language of pharmacy (NDCs) into the language of medical billing (HCPCS codes). TakeawaysUnderstand the purpose of the NDC/HCPCS Crosswalk and why it is essential for pharmacy billing.Learn why NDC-to-HCPCS relationships are at times many-to-one or one-to-many rather than simple one-to-one mappings.Explore real-world crosswalk examples involving prednisone, enoxaparin, normal saline, argatroban, and buprenorphine.See how HCPCS billing units are calculated using drugs such as pembrolizumab and rituximab.Discover why quarterly CMS crosswalk updates are critical for maintaining an accurate CDM and compliant billing workflows.Understand how payer-specific crosswalks can differ from CMS guidance and contribute to claim edits and denials. Chapters 00:00 Introduction 00:27 The Rosetta Stone of Pharmacy Billing 01:52 Real-World Crosswalk Examples 04:08 Billing Units and Quarterly Updates 06:00 Payer Differences Disclaimer This podcast is intended for informational and educational purposes only. The views expressed are personal opinions and do not represent those of any employer or affiliated organization. This content does not constitute legal, financial, compliance, reimbursement, or clinical advice. Healthcare regulations, payer policies, and reimbursement requirements vary by organization and jurisdiction. Always consult your internal compliance, legal, finance, revenue cycle, and operational teams before implementing any strategy discussed in this episode.

  2. Jul 20

    💣 The 340B Bombshell No One Saw Coming 💣

    Description CMS has proposed one of the most significant changes to 340B reimbursement since the Supreme Court's 2022 decision in American Hospital Association v. Becerra. In this special episode of Revenue RX, we break down the Calendar Year 2027 Hospital Outpatient Prospective Payment System (OPPS) proposed rule and explain what it could mean for hospitals participating in the 340B Drug Pricing Program. Whether you work in pharmacy, finance, revenue cycle, compliance, or executive leadership, this episode provides the context and financial perspective needed to begin assessing your organization's exposure. Takeaways CMS has proposed reducing Medicare reimbursement for 340B-acquired drugs to ASP minus 33.4% beginning in CY 2027.The proposal follows a new CMS acquisition cost survey intended to address the legal issues identified by the Supreme Court in 2022.CMS estimates the proposal would reduce Medicare drug payments by approximately $4.55 billion in the first year.CMS also proposes accelerating the OPPS budget neutrality offset from 0.5% to 3% annually, completing the $7.8 billion remedy recovery by 2029.Health systems could experience simultaneous impacts to both drug reimbursement and non-drug OPPS payments.Organizations should model their financial exposure using current and proposed payment methodologies.Comments on the proposed rule are due by August 31, 2026.Pharmacy and finance leaders should work together to evaluate multiple budget scenarios until the final rule is released. Chapters 00:00 CMS Proposes Major 340B Payment Changes 00:57 The History: ASP -22.5%, the Supreme Court, and the Remedy 02:34 The New Proposal: ASP -33.4% 04:02 The Accelerated Clawback and Budget Neutrality 05:02 Financial Implications for Health Systems 05:56 Why the Precedent Matters 06:23 Four Actions to Take Now 08:20 Disclaimer References CMS CY 2027 OPPS Proposed Rule Fact SheetCMS-1850-P Proposed RuleCMS Hospital Outpatient PPSHRSA 340B Drug Pricing Program Disclaimer This podcast is intended for informational and educational purposes only. The views expressed are personal opinions and do not represent those of any employer or affiliated organization. This content does not constitute legal, financial, compliance, reimbursement, or clinical advice. Consult your internal compliance, legal, finance, and revenue cycle teams before making any decisions.

  3. Jul 13

    The Missing Adjective: Why Modifiers Matter

    Modifiers may be only two characters long, but they can make or break a claim. In this episode of Revenue RX, we explore why modifiers are like adjectives, adding the context that completes the story behind a claim. Learn about JW and JZ, the latest 340B modifier changes, modifiers for routes of administration, ESA and ESRD billing, and common mistakes that can lead to denials, payment delays, and audit findings. Takeaways Understand what modifiers are and why they provide essential context to HCPCS and CPT codes.Learn when to report JW and JZ for drugs.Discover why CMS requires discarded drug reporting.Understand the latest 340B modifier requirements, including JG, TB, and UD.Learn when to use JA and JB to identify the route of administration.Review ESA modifiers (EA, EB, and EC) and the AY modifier for ESRD-related billing.Recognize common modifier mistakes that can result in denials, audits, and payment recoupments.Understand why modifier requirements vary by payer and should always be verified. Chapters 00:00 Introduction: Why Modifiers Matter 00:22 What Is a Modifier? 01:11 Reporting Drug Waste: JW and JZ 01:46 Choosing the Right Vial Size 02:46 Why CMS Requires JW and JZ 04:46 340B Modifiers: JG, TB, and UD 06:40 Routes of Administration: JA and JB 07:04 ESA Modifiers: EA, EB, and EC 07:25 ESRD Modifier: AY 08:03 Common Modifier Mistakes 08:41 Disclaimer References CMS Medicare Program: Discarded Drugs and Biologicals (JW and JZ Modifier) Frequently Asked QuestionsCMS Billing and Coding: JW and JZ Modifier Billing GuidelinesCMS Billing 340B Modifiers Under the Hospital Outpatient Prospective Payment System (OPPS) FAQ Disclaimer This podcast is intended for informational and educational purposes only. The views expressed are personal opinions and do not represent those of any employer or affiliated organization. This content does not constitute legal, financial, compliance, reimbursement, or clinical advice. Healthcare regulations, payer policies, and reimbursement requirements vary by organization and jurisdiction. Always consult your internal compliance, legal, finance, revenue cycle, and operational teams before implementing any strategy discussed in this episode.

  4. Jul 6

    Exploring Pharmacy Revenue Codes

    Revenue codes are one of the foundational elements of hospital billing, yet they are often misunderstood. In this episode of Revenue RX, we discuss what revenue codes are, how they function on the UB-04 claim form, and why they play an important role in pharmacy reimbursement. The episode walks through the four primary pharmacy revenue code ranges, 025X, 026X, 063X, and 089X, explaining what each category represents and how pharmacy billing has evolved as medications have become more specialized and complex. You will also hear practical examples of the revenue codes most commonly used by health systems, how payer reimbursement can vary based on the revenue code selected, and common billing mistakes that pharmacy and revenue cycle teams should avoid to protect reimbursement. Takeaways Learn what revenue codes are and how they categorize services on the UB-04 claim form.Learn why revenue code 0636 requires submission of both the HCPCS code and the NDC.Understand how pharmacy billing requirements have evolved as drug therapies have become more specialized.Explore the revenue codes most commonly used by health systems.Learn how payer reimbursement may vary depending on the revenue code billed. Chapters 00:00 Understanding Revenue Codes 01:45 The 025X Pharmacy Revenue Codes 02:35 The 026X IV Therapy Revenue Codes 03:00 The 063X Detailed Drug Billing Codes 03:31 The New 089X Cell and Gene Therapy Codes 05:06 Common Revenue Codes Used by Health Systems 06:18 Revenue Codes, Payer Requirements, and Common Billing Mistakes Disclaimer This podcast is for informational and educational purposes only. The views shared are my own and do not represent any organization that I am affiliated with. This is not legal, financial, or reimbursement advice. You should consult with your internal experts before making any decisions.

  5. Jun 29

    The UB-04: Every Claim Tells a Story

    What if the UB-04 claim form wasn't just a collection of boxes and billing codes, but an epic story? In this episode of Revenue RX, we reimagine the institutional claim form as a journey through a medieval kingdom. The patient becomes the hero, the hospital becomes the storyteller, and the payer becomes the king deciding whether the story deserves a bag of gold. Along the way, we explore how every section of the UB-04 (CMS-1450) helps tell the complete reimbursement story, from patient demographics and Type of Bill to diagnosis codes, revenue codes, HCPCS, NDCs, prior authorization, and provider information. Takeaways Learn the purpose and structure of the UB-04 (CMS-1450) institutional claim form.Understand how each form locator contributes to the reimbursement story.Discover why Type of Bill, diagnosis codes, revenue codes, HCPCS, NDCs, and authorization numbers are critical for payment.See how incomplete or inconsistent claim information can lead to denials and payment delays.Gain a memorable storytelling framework for explaining reimbursement concepts to pharmacy, finance, and revenue cycle teams.Understand why successful reimbursement depends on telling a complete, accurate, and medically necessary story. Chapters 00:00 Introduction to the UB-04 Claim Form 01:57 Once Upon a Claim 03:38 Meet the Hero 04:47 The Plot Thickens 06:17 Hidden Clues 06:54 The Action Begins 09:38 The King Takes the Throne 10:38 The Royal Family Tree 11:45 The Villain Appears 12:46 The Final Battle 13:14 The Supporting Cast Disclaimer This podcast is intended for informational and educational purposes only. The views expressed are personal opinions and do not represent those of any employer or affiliated organization. This content does not constitute legal, financial, compliance, reimbursement, or clinical advice. Healthcare regulations, payer policies, and reimbursement requirements vary by organization and jurisdiction. Always consult your internal compliance, legal, finance, revenue cycle, and operational teams before implementing any strategy discussed in this episode.

  6. Jun 22

    Building Your Revenue Cycle Dictionary

    Healthcare reimbursement has a language all its own. In this episode of Revenue RX, we break down the essential reimbursement terminology that drives healthcare finance and pharmacy revenue cycle management. Whether you're new to revenue cycle or looking to strengthen your financial acumen, this episode provides a foundational understanding of the acronyms, coding structures, and payment concepts that influence how healthcare organizations get paid. Takeaways • Understand the difference between billed charges, allowed amounts, and contractual adjustments. • Learn why net revenue is a more meaningful financial metric than gross revenue. • Distinguish between claim rejections and denials and understand their operational impact. • Learn how CARCs and RARCs explain payment outcomes and denial reasons. • Understand the role of remittance advice in the reimbursement process. • Review revenue codes and modifiers. • Learn the difference between HCPCS and CPT coding systems and how they work together. • Gain familiarity with common drug pricing terminology including ASP, WAC, AWP, GPO, and 340B. • Explore Medicare payment methodologies including APCs and DRGs. • Understand important Medicare coverage and billing concepts such as NCDs, LCDs, LCAs, MACs, and MUEs. Chapters 00:00 Understanding Healthcare Reimbursement Language 00:56 Billed Charge 01:31 Allowed Amount 02:04 Contractual Adjustment 02:32 Gross Revenue & Net Revenue 03:01 Revenue Cycle 03:42 Denials vs Rejections 04:35 CARCs & RARCs 05:16 The Remittance Advice 05:36 Revenue Codes 05:59 Modifiers 06:35 HCPCS 07:21 CPT 07:53 NDC 08:06 Drug Pricing Terminology 08:36 APC 08:48 DRG 09:07 MAC 09:35 NCD 09:42 LCD 09:50 LCA 09:59 MUE 10:15 Learning the Language 10:55 Disclaimer Disclaimer This podcast is intended for informational and educational purposes only. The views expressed are personal opinions and do not represent those of any employer or affiliated organization. This content does not constitute legal, financial, compliance, reimbursement, or clinical advice. Healthcare regulations, payer policies, and reimbursement requirements vary by organization and jurisdiction. Always consult your internal compliance, legal, finance, revenue cycle, and operational teams before implementing any strategy discussed in this episode.

  7. Jun 15

    The Revenue Cycle Ecosystem

    A practical walkthrough of the revenue cycle ecosystem and how each team contributes to moving care from access to payment. This episode explains the roles of managed care, preaccess, pharmacy, clinical teams, revenue integrity, IT, HIM, coding, patient financial services, finance, and compliance, and why pharmacy leaders need to understand the full process. Takeaways Revenue cycle success depends on coordinated handoffs across many teams.Managed care sets the rules that shape coverage, authorization, and reimbursement.Pharmacy plays a key role early in the process through medication-related documentation, authorization, and operational coordination.Revenue integrity connects clinical care, charge capture, coding, billing, and compliance.Pharmacy leaders should build relationships across revenue cycle, finance, compliance, and operations. Chapters 00:00 Understanding the Revenue Cycle Ecosystem 01:53 Managed Care: Setting the Rules of the Game 03:26 Preaccess Teams: The Front Line 04:45 Pharmacy: The First Handoff 05:46 Clinical: Delivering and Documenting Care 06:45 Revenue Integrity: The Connective Tissue 09:11 IT: Building the Track 09:42 HIM: Protecting the Medical Record 10:26 Coding: Translating Care Into Billable Data 11:15 Patient Financial Services: Turning Claims Into Cash 12:02 Finance: Measuring Financial Performance 12:40 Compliance: The Referee 13:19 The Dream Team 14:20 What Pharmacy Leaders Should Do 15:38 Disclaimer Disclaimer This podcast is intended for informational and educational purposes only. The views expressed are personal opinions and do not represent those of any employer or affiliated organization. This content does not constitute legal, financial, compliance, reimbursement, or clinical advice. Healthcare regulations, payer policies, and reimbursement requirements vary by organization and jurisdiction. Always consult your internal compliance, legal, finance, revenue cycle, and operational teams before implementing any strategy discussed in this episode.

  8. Jun 8

    🚨 July 2026 CMS HCPCS Quarterly Update 🚨

    The podcast explores the July 2026 HCPCS coding updates and their impact on pharmacy revenue cycle operations. It reviews new drug and biosimilar HCPCS codes, deleted and reinstated codes, CMS's continued approach to 505(b)(2) products, and newly established administration codes. The episode emphasizes the operational importance of timely code implementation, reimbursement readiness, and cross-functional coordination to prevent denials, underpayments, and revenue leakage following the July 1 go-live. Takeaways Understanding the July 2026 HCPCS Coding UpdatesPreparing Revenue Cycle Operations for July 1 Go-LiveEvaluating New Biosimilar Reimbursement ImplicationsUnderstanding CMS 505(b)(2) Billing Methodology ChangesOperationalizing New Drug Administration CodesReducing Revenue Leakage Through Proactive Readiness Assessments Chapters 00:00 CMS July 2026 Updates 01:38 New HCPCS Codes 03:14 Biosimilar Additions 04:38 Deleted and Reinstated Codes 05:57 Understanding 505(b)(2) Products 06:08 Impact of 505(b)(2) Products on Reimbursement 06:44 New M-Codes and Administration Billing 08:21 Are You Ready for Go-Live? 09:31 Disclaimer References Centers for Medicare & Medicaid Services. (2026). HCPCS quarterly update July 2026 coding decisions. U.S. Department of Health and Human Services. https://www.cms.gov/medicare/coding-billing/healthcare-common-procedure-system/quarterly-update Centers for Medicare & Medicaid Services. (2026, April 8). MLN Matters MM14470: July 2026 HCPCS quarterly update. U.S. Department of Health and Human Services. https://www.cms.gov/files/document/mm-14470-vaccine-administration-national-fee-schedule-july-2026-quarterly-update.pdf Disclaimer This podcast is intended for informational and educational purposes only. The views expressed are personal opinions and do not represent those of any employer or affiliated organization. This content does not constitute legal, financial, compliance, reimbursement, or clinical advice. Healthcare regulations, payer policies, and reimbursement requirements vary by organization and jurisdiction. Always consult your internal compliance, legal, finance, revenue cycle, and operational teams before implementing any strategy discussed in this episode.

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About

Revenue Rx is a podcast at the intersection of pharmacy and finance, designed to simplify the complexities of pharmacy revenue cycle management. Hosted by Lubna Mazin, PharmD, MS, 340B ACE a pharmacy leader with experience across health system operations, specialty pharmacy, and revenue cycle strategy, this podcast breaks down the systems that drive reimbursement, margin, and patient access. From drug pricing and payer dynamics to CMS updates and high-cost therapies, each episode translates real-world challenges into practical insights you can actually use. Whether you are new to pharmacy revenue cycle or deep in the work, Revenue Rx is your space to connect the dots, build confidence, and stay ahead in a rapidly evolving landscape. Healing patients is the mission. Protecting the margin is the strategy. This is Revenue Rx.

Information

  • Creator
    Lubna Mazin
  • Years Active
    2026
  • Episodes
    18
  • Rating
    Clean
  • Copyright
    © 2026 Lubna Mazin
  • Show Website
    Revenue Rx