Pharmacy Charges

As of 7/1/24, hospital pharmaceutical charges must be included in MRFs when the CDM has a billing code and charge amount associated with the service. In some cases, pharmacy charges are housed in separate pharmacy or formulary files within the electronic health record (EHR) system.

Starting 1/1/25, CMS requires additional MRF elements for reporting drug information. Specifically, the National Drug Code (NDC) must be included alongside the drug unit of measurement and drug type of measurement details. These details generally come from a pharmacy formulary or another specific file. When an NDC is included, it must be accompanied by the relevant unit of measurement and drug type, as specified in the schema.

At Turquoise, if customers provide the necessary information to satisfy the 1/1/25 requirements ahead of schedule, we incorporate the elements into MRFs in a compliant manner. Otherwise, we proactively work with hospitals to get the additional information needed to ensure that the files generated after 1/1/25 to meet the updated requirements.