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5 Ways Your Pharmacy Can Boost Your Revenue Cycle
November 3, 2016
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Speakers
Dana FoxProgram Development ManagerCompleteRx, Ltd
Justin Sotomayor, PharmDDirector of Pharmacy InformaticsCompleteRx, Ltd
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Today’s Objectives
1. Outline critical stages of the hospital revenue cycle
2. Review best practices for revenue cycle management
3. Identify new pharmacy-led revenue streams
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Challenges
• Regulatory and market changes
• Payor practices
• Technology
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What is your biggest revenue cycle challenge today?A. Regulations and market changes
B. Payor practices
C. Technology
Quick Poll
HOSPITALREVENUE CYCLE
A/R and Denial Processing
Patient Registration and Insurance Verification
Patient Exam and Treatment Prescribed
Pharmacy Formularyand Purchasing
Dispensing Transactions and Informatics
Patient BillingPatient Assistance/Retail Med Dispensing
Payment Processing
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5 Ways Pharmacy Can Impact Revenue Cycle
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Patient Exam and Treatment Prescribed
Patient exam• Clinician exam
Treatment prescribed• Inpatient impact areas• Outpatient impact areas
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Pharmacy Formulary and Purchasing
Updated formulary
• Restricted formulary
• Extensive non-formulary use process
• Bulk and specialty drug restrictions
Pharmacy buyers’ involvement• Aligning systems• Managing the data and line items
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Dispensing Transactions & Informatics
Medication dispensing process• Staffing efficiencies• Pharmacy automation
Pharmacy drug dictionary build • Dispensing units vs. billing units• Bulk product setup• Single and multi-dose vials
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Patient Billing
Charge Description Master (CDM) updates• Drugs constantly changing in price• Regularly review/update CDM• NDC updates• Examples: Daraprim, Vasostrict ,EpiPen, Insulin
products
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Patient Billing
CMS HCPCS J-Code and modifiers• Used to bill Medicare part B for injectables and
specialty drugs (oral chemo, etc.)• Reimbursable billing units• Missing or wrong codes or multipliers leads to less
reimbursementAmpicillin/Sulbactam – Jcode of J0295Billing unit = 1.5gPayment allowance limit = $3.69/unit or = $7.39/3g dose
$4,040.55 per patient
treatment day (annually)
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Patient Assistance & Retail Dispensing
Patient Assistance
• Access to costly therapies
Specialty Pharmacy
• Integration with other services
Retail Pharmacy
• Control discharge medications and customer refills
• Capture clinic patient prescriptions
• Vaccinations
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Which initiative would benefit your hospital or health system most?A. Clinical
B. Pharmacy Purchasing
C. Informatics/Technology
D. Patient Billing/CDM
E. Retail/Patient Assistance
Quick Poll
