STATISTICS

Claim scrubber or biller should avoid rolling up NDCs to the largest vial size in situations where it would result in inaccurate billing or overcharging. Here are a few scenarios where this may occur:

Different dosages: If multiple dosages of the same medication are used, rolling up NDCs to the largest vial size may result in overcharging for patients who receive a lower dosage. For example, if a medication is available in both 50mg and 100mg doses, rolling up to the 100mg vial size for a patient who only receives 50mg would result in overcharging.

Different routes of administration: If a medication is available in different formulations for different routes of administration (such as oral and injectable), rolling up to the largest vial size may result in inaccurate billing if the patient received a different formulation.

Different billing requirements: Some payers or insurance plans may have specific requirements for how medication should be billed, such as billing by NDC or using a specific unit of measurement. In these cases, rolling up to the largest vial size may not be appropriate.

Patient-specific factors: Finally, there may be patient-specific factors that make rolling up to the largest vial size inappropriate, such as allergies or adverse reactions to certain medications. In these cases, the medication may need to be administered in smaller doses or different formulations, which would require separate billing for each NDC.