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.
Under Medicare Part A, administering an expensive medication doesn't necessarily mean a hospital receives additional reimbursement.
In this episode of Revenue Rx, we break down how Medicare reimburses inpatient hospital stays, why most medications are included in bundled payments, and what that means for pharmacy financial performance.
From understanding MS-DRGs to managing high-cost therapies, we'll explore why protecting the margin under Medicare Part A requires a different approach to pharmacy revenue cycle management.
Key Takeaways
Medicare Part A generally pays hospitals based on MS-DRGs, not individual medications.
Higher costs ≠ higher payments: Expensive drugs don't automatically increase reimbursement.
Accurate charges support cost accounting, utilization analysis, and reimbursement.
Outlier payments and NTAP may provide additional reimbursement for qualifying cases.
Managing drug costs, monitoring utilization, and maintaining accurate charge capture are essential.
Chapters
00:02 Introduction: Medicare Part A
01:01 Medicare Eligibility & Coverage
02:58 Inpatient Reimbursement: IPPS & MS-DRGs
04:10 How Bundled Payments Impact Pharmacy
05:05 Why Charge Capture Still Matters
06:09 High-Cost Drugs, Outliers & NTAP
07:23 Pharmacy Revenue Cycle Priorities
08:18 Key Takeaways & What's Next
09:12 Disclaimer
References
Medicare.gov: Get Started with Medicare (https://www.medicare.gov/basics/get-started-with-medicare)
CMS: Acute Inpatient Prospective Payment System (IPPS) (https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps)
CMS: Inpatient Prospective Payment System Overview (https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/payment/ipps)
CMS: Outlier Payments (https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/outlier-payments)
CMS: New Medical Services and New Technologies (NTAP) (https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/new-medical-services-and-new-technologies)
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.
26 Oct 2026
From Medicare to CMS: 60 Years of Healthcare Reimbursement
How did Medicare and Medicaid evolve into one of the most influential forces shaping healthcare reimbursement?
In this episode of Revenue Rx, we explore more than 60 years of healthcare policy, from the creation of Medicare and Medicaid in 1965 to prospective payment systems, Medicare Part D, and modern drug pricing reform. Discover how these milestones shaped pharmacy reimbursement, hospital finances, and the revenue cycle we navigate today.
Takeaways
How Medicare and Medicaid transformed healthcare financing in 1965.
Why the introduction of DRGs in 1983 changed hospital reimbursement and pharmacy cost management.
How CHIP expanded healthcare coverage for children.
How OPPS introduced APCs, drug packaging, and separate payment methodologies.
Why Medicare Part D reshaped outpatient prescription drug coverage.
How the Affordable Care Act and CMMI accelerated payment innovation.
Why Medicare drug price negotiation represents another turning point in pharmaceutical reimbursement.
How understanding CMS history helps pharmacy and revenue cycle teams prepare for future policy changes.
Chapters
00:43 1965: The Birth of Medicare and Medicaid
03:04 1977: From HCFA to CMS
03:39 1983: The DRG Revolution
05:29 1997: Expanding Coverage Through CHIP
06:05 2000: The Rise of OPPS
07:18 2003: Medicare Part D Changes Pharmacy
08:33 2010: The Affordable Care Act and CMMI
09:23 2022: Medicare Drug Price Negotiation
10:05 Why CMS History Matters Today
12:30 Disclaimer
References
CMS: History (https://www.cms.gov/about-cms/who-we-are/history)
Medicare: Medicare & You (https://www.medicare.gov/medicare-and-you)
CMS: Hospital Inpatient Prospective Payment Systems (https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps)
CMS: Hospital Outpatient PPS (https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient)
Medicaid: Children's Health Insurance Program (https://www.medicaid.gov/chip)
CMS Innovation Center (https://www.cms.gov/priorities/innovation)
CMS: Medicare Drug Price Negotiation Program (https://www.cms.gov/inflation-reduction-act-and-medicare/medicare-drug-price-negotiation)
Disclaimer
This podcast is for informational and educational purposes only. The views shared are my own and do not represent any organization I am affiliated with. This is not legal, financial, or reimbursement advice, and you should consult your internal experts before making decisions.
19 Oct 2026
GLOBE Final Rule: What It Means for Medicare Part B
CMS has finalized the GLOBE Model, introducing international drug pricing benchmarks for select Medicare Part B drugs. But the final rule looks significantly different from the original proposal.
In this episode of Revenue RX, Lubna Mazin breaks down what changed, how reduced patient coinsurance affects provider reimbursement, and what pharmacy revenue cycle, finance, and patient financial services teams need to know before implementation begins in 2027.
Takeaways
GLOBE is a mandatory five-year Medicare Part B model using international pricing benchmarks to calculate manufacturer rebates.
The final rule narrows participation to approximately 25% of eligible Original Medicare beneficiaries and reduces projected Medicare savings from $2.3 billion to approximately $80 million.
Reduced patient coinsurance does not reduce the provider's Medicare allowed payment. Medicare increases its share to offset the difference.
Beneficiary eligibility is based on the patient's address of record, not the hospital's location.
No special billing modifier or separate billing system is required, but inaccurate patient estimates could create overcollections and refunds.
Organizations should evaluate drug exposure, prepare patient financial services, validate reimbursement and reconciliation workflows, and assign ongoing oversight.
Chapters
00:00 Introduction to the GLOBE Model
00:46 What Is the GLOBE Model?
01:00 International Drug Pricing Benchmarks
02:19 Implementation Timeline
02:49 What Changed Between the Proposed and Final Rule?
05:06 Provider Reimbursement and Revenue Cycle Impact
07:40 Five Steps to Prepare for GLOBE
References
CMS GLOBE Model Final Rule (https://www.cms.gov/priorities/innovation/innovation-models/globe)
CMS GLOBE Model Frequently Asked Questions (FAQ) (https://www.cms.gov/priorities/innovation/globe-model-frequently-asked-questions)
Disclaimer
This podcast is for informational and educational purposes only. The views shared are my own and do not represent any organization I am affiliated with. This is not legal, financial, or reimbursement advice, and you should consult your internal experts before making decisions.
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5.0 / 5
6 ratings
Spotify
5.0 / 5
5 ratings
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