Revenue Rx

Lubna Mazin

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.

Episodes

  1. 1d ago

    🚨 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.

    10 min

  2. Jun 1

    The Pharmacy Revenue Cycle Mid-Year Checklist

    The podcast explores how pharmacy revenue cycle leaders can use the midpoint of the year to evaluate financial performance, identify reimbursement risks, and strengthen operational processes before entering the second half of the year. The episode walks through five critical assessments that can help organizations improve reimbursement integrity, reduce revenue leakage, and prepare for upcoming fiscal and regulatory changes. Takeaways Evaluating Mid-Year Financial PerformanceIdentifying Denial Trends and Reimbursement RisksImproving Charge Capture and Revenue IntegrityAssessing Underpayment OpportunitiesMeasuring Prior Authorization EffectivenessReviewing Aging Accounts Receivable* Preparing for the Second Half of the Fiscal Year Chapters 00:00 Introduction: Why June Matters 01:33 Financial Performance Review 02:48 Denials Analysis 04:14 Charge Capture and Missing Revenue 06:13 Underpayment Analysis 07:39 Prior Authorization Performance 09:08 Aging Accounts Receivable 09:52 Finding Risk Before Year-End 11:02 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 min

  3. May 25

    The 835 File: Where Claims Turn Into Cash

    The podcast delves into the operational significance of the 835 remittance advice file in pharmacy revenue cycle management. It emphasizes the importance of understanding and leveraging the 835 file for reimbursement integrity, operational intelligence, and financial sustainability. Takeaways Operational Significance of the 835 FileLeveraging Remittance Data for Reimbursement Integrity Chapters 00:00 835 Remittance Advice01:47 Breaking Down the 83505:46 Utilizing the 835 to Improve Performance 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.

    9 min

  4. May 18

    One Drug, Three Billing Pathways

    In this week's episode, we dive into the different claim pathways used to bill medications, including NCPDP D.0 for pharmacy benefits, 837P for professional claims, and 837I for institutional claims. Takeaways Different claim pathways for medication billingUnderstanding the impact of claim pathways on reimbursement and operational workflows Chapters 00:00 Introduction to Pharmacy Revenue Cycle Management 01:08 Pharmacy Benefit Claims: NCPDP D.0 04:05 Medical Benefit Claims: 837P 05:23 Medical Benefits Claim: 837I 06:10 Takeaway 08:08 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, reimbursement, compliance, or operational advice. Always consult your internal compliance, legal, finance, and revenue cycle teams before implementing any strategy discussed in this episode.

    9 min

  5. May 11

    Every Breath You Take, Revenue is at Stake

    In this episode of Revenue Rx, we explore one of the most significant hidden threats in healthcare finance: pharmacy revenue leakage. The episode walks backward through the pharmacy revenue cycle, starting with reimbursement and denials management, then moving upstream into coding, charge capture, documentation, and prior authorizations. The discussion highlights how reimbursement is connected to every handoff, workflow, click, and documentation requirement across the healthcare system. Small operational failures can create major downstream financial consequences, including denials, underpayments, compliance exposure, and permanent revenue loss. Takeaways Revenue leakage is often caused by small operational breakdowns that compound across the revenue cycle.Denials management requires structured workflows, clear escalation pathways, and ongoing follow-up.Strong pharmacy revenue cycle management depends on cross-functional collaboration across clinical, financial, and operational teams.High-performing organizations use denials and reimbursement trends to improve workflows upstream. Chapters 00:00 Introduction to Revenue Leakage01:21 Reimbursement & Denials04:16 Billing, Coding & Charge Integrity05:52 Documentation & Medical Necessity06:58 Prior Authorizations & Financial Risk08:18 The Importance of Cross-Functional Collaboration09:24 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.

    10 min

  6. May 4

    The Bagging Crisis

    The bagging crisis in healthcare is a significant issue that impacts patient care, operational efficiency, and financial sustainability. It involves various models such as brown bagging, white bagging, orange bagging, clear bagging, and gold bagging, each with its own set of challenges and implications. The crisis is not just about drug distribution but also about misaligned incentives, fragmentation, and the ability of health systems to sustain high-cost, high-complexity care. Takeaways Bagging crisis impacts patient care, operational efficiency, and financial sustainabilityDifferent bagging models have unique challenges and implications Chapters 00:00 Introduction to the Bagging Crisis00:34 Patient Impact02:08 Impacted Therapies03:46 Buy & Bill04:35 Brown Bagging05:22 White Bagging06:01 Orange Bagging07:20 Clearbagging09:27 Gold Bagging12:07 DIsclaimer Links Vizient Survey on the Patient Care Impact and Additional Expense of White/brown Bagging ASHP White-Bagging Infographic Asembia Specialty Pharmacy Drive-by Model Disclaimer This podcast is for informational and educational purposes only. The content shared reflects my personal views and experiences and does not represent the views of my employer, any affiliated organizations, or any institutions I am associated with. Nothing discussed on this podcast should be interpreted as legal, financial, medical, or reimbursement advice. Listeners should consult their own legal counsel, compliance teams, or qualified professionals before making any decisions based on this content. All examples and scenarios discussed are generalized or de-identified to protect confidentiality and comply with applicable privacy laws. While I strive to provide accurate and up-to-date information, healthcare regulations, payer policies, and reimbursement models are constantly evolving, and I make no guarantees regarding completeness or accuracy. By listening to this podcast, you acknowledge and agree that any reliance on the information provided is at your own risk.

    13 min

  7. Apr 27

    From Authorization to Payment: Strengthening the Front End of Revenue Cycle

    The podcast discusses the critical role of prior authorizations in determining reimbursement and highlights the importance of understanding the differences in reimbursement processes for pharmacy and medical benefits. It also delves into the definitions of key terms related to prior authorizations, common challenges, ownership, centralized models, and the role of artificial intelligence in reshaping prior authorization workflows. Takeaways Prior authorizations are critical for determining reimbursementUnderstanding the different reimbursement processes for pharmacy and medical benefits is essential Chapters 0:02 Introduction1:05 Why Prior Authorizations Matter2:16 Pharmacy vs. Medical Benefits3:53 Key Terms Defined6:08 Where Organizations Go Wrong8:57 High-Performing Organizations & AI11:13 Disclaimer Links 2024 AMA Prior Authorization Physician Survey Disclaimer This podcast is for informational and educational purposes only. The content shared reflects my personal views and experiences and does not represent the views of my employer, any affiliated organizations, or any institutions I am associated with. Nothing discussed on this podcast should be interpreted as legal, financial, medical, or reimbursement advice. Listeners should consult their own legal counsel, compliance teams, or qualified professionals before making any decisions based on this content. All examples and scenarios discussed are generalized or de-identified to protect confidentiality and comply with applicable privacy laws. While I strive to provide accurate and up-to-date information, healthcare regulations, payer policies, and reimbursement models are constantly evolving, and I make no guarantees regarding completeness or accuracy. By listening to this podcast, you acknowledge and agree that any reliance on the information provided is at your own risk.

    18 min

  8. Apr 20

    You Can’t Bill What You Don’t Capture: The Hidden Gaps in Pharmacy Revenue

    This episode dives into the critical operational discipline of charge capture, highlighting the importance of bridging care delivery and reimbursement. It explores the advantages and risks of charge on administration and charge on dispense, emphasizing the impact of mischarges on revenue and the need for reconciliation. We also cover the challenges of charge capture in clinics and the assessment of medication areas and waste capture. Takeaways Charge capture is a critical operational discipline that bridges care delivery and reimbursement.Charge on administration (COA) aligns revenue with patient care, while charge on dispense (COD) aligns revenue with operational activity.Clinics are a major source of silent leakage due to low volume and visibility.Reconciliation is a crucial part of charge capture, comparing what was purchased, dispensed, administered, and billed. Disclaimer This podcast is for informational and educational purposes only. The content shared reflects my personal views and experiences and does not represent the views of my employer, any affiliated organizations, or any institutions I am associated with. Nothing discussed on this podcast should be interpreted as legal, financial, medical, or reimbursement advice. Listeners should consult their own legal counsel, compliance teams, or qualified professionals before making any decisions based on this content. All examples and scenarios discussed are generalized or de-identified to protect confidentiality and comply with applicable privacy laws. While I strive to provide accurate and up-to-date information, healthcare regulations, payer policies, and reimbursement models are constantly evolving, and I make no guarantees regarding completeness or accuracy. By listening to this podcast, you acknowledge and agree that any reliance on the information provided is at your own risk.

    10 min

  9. Apr 13

    Drug Pricing Explained: The Numbers That Drive Margin

    This episode delves into the complexity of drug pricing and the impact of reimbursement on margin. It covers the alphabet soup of drug pricing, WAC, GPO pricing, the 340B program, ASP, AWP, and AAC. Takeaways Complexity of drug pricingImpact of reimbursement on margin Disclaimer This podcast is for informational and educational purposes only. The content shared reflects my personal views and experiences and does not represent the views of my employer, any affiliated organizations, or any institutions I am associated with. Nothing discussed on this podcast should be interpreted as legal, financial, medical, or reimbursement advice. Listeners should consult their own legal counsel, compliance teams, or qualified professionals before making any decisions based on this content. All examples and scenarios discussed are generalized or de-identified to protect confidentiality and comply with applicable privacy laws. While I strive to provide accurate and up-to-date information, healthcare regulations, payer policies, and reimbursement models are constantly evolving, and I make no guarantees regarding completeness or accuracy. By listening to this podcast, you acknowledge and agree that any reliance on the information provided is at your own risk.

    7 min

  10. Apr 13

    🚨 April 2026 CMS HCPCS Quarterly Update 🚨

    In this episode, we explore the April 2026 CMS HCPCS quarterly update and its significance for organizations. We delve into the HCPCS transaction file, the Addendum B, and the NDC to HCPCS crosswalk, emphasizing the importance of understanding these files for protecting margins and reimbursement strategies. Takeaways CMS Quarterly Updates are a reimbursement roadmapUnderstanding the CMS files is crucial for protecting margins Links HCPCS Quarterly Update Quarterly Addenda Updates ASP Pricing Files Disclaimer This podcast is for informational and educational purposes only. The content shared reflects my personal views and experiences and does not represent the views of my employer, any affiliated organizations, or any institutions I am associated with. Nothing discussed on this podcast should be interpreted as legal, financial, medical, or reimbursement advice. Listeners should consult their own legal counsel, compliance teams, or qualified professionals before making any decisions based on this content. All examples and scenarios discussed are generalized or de-identified to protect confidentiality and comply with applicable privacy laws. While I strive to provide accurate and up-to-date information, healthcare regulations, payer policies, and reimbursement models are constantly evolving, and I make no guarantees regarding completeness or accuracy. By listening to this podcast, you acknowledge and agree that any reliance on the information provided is at your own risk.

    12 min

  11. Apr 13

    What is the Pharmacy Revenue Cycle and Why it Matters Now

    This episode covers the strategic role of the pharmacy revenue cycle, the operational and financial complexity of pharmacy, and the importance of alignment among pharmacy, revenue cycle, and finance. Takeaways Pharmacy revenue cycle as a strategic driverAligning pharmacy, revenue cycle, and financeOperational and financial complexity in pharmacyCreating an integrated system for pharmacy revenue cycle Links ASHP Pharmacy Revenue Cycle Management Certificate Disclaimer This podcast is for informational and educational purposes only. The content shared reflects my personal views and experiences and does not represent the views of my employer, any affiliated organizations, or any institutions I am associated with. Nothing discussed on this podcast should be interpreted as legal, financial, medical, or reimbursement advice. Listeners should consult their own legal counsel, compliance teams, or qualified professionals before making any decisions based on this content. All examples and scenarios discussed are generalized or de-identified to protect confidentiality and comply with applicable privacy laws. While I strive to provide accurate and up-to-date information, healthcare regulations, payer policies, and reimbursement models are constantly evolving, and I make no guarantees regarding completeness or accuracy. By listening to this podcast, you acknowledge and agree that any reliance on the information provided is at your own risk.

    14 min
  • 11 Episodes

Ratings & Reviews

5
out of 5
5 Ratings

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
    2K
  • Episodes
    11
  • Rating
    Clean
  • Copyright
    © 2026 Lubna Mazin
  • Show Website
    Revenue Rx

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