Pharmacy Revenue Cycle Solutions
The Pharmacy is an increasingly important yet often overlooked aspect of the Revenue Cycle. A complete understanding of its complexities, from acquisition to payment, is vital to ensure compliance, minimize lost revenue, identify systemic issues and develop plans for improvement.
Drug Pricing Understanding the pricing formula’s that reside in the Pharmacy Information System is the key to un-coding Pharmacy pricing. Developing and maintaining pricing formulas by Drug Classification allow Providers to capture acquisition cost as well as labor and carrying costs for specific drug classes. SunStone can assist your hospital implement processes that leverage Pharmacy, Information System and Revenue Cycle Management to significantly reduce pricing errors by drug classification. Based on our experience the following opportunities often exist:
Formula‘s that are outdated or do not effectively cover the costs of dispensing the drugs; Pharmaceuticals that are not appropriately mapped to the Price Schedule; Formularies that that do not incorporate updated cost data; Inappropriate linking of pharmaceuticals from the pharmacy charging system to the hospital billing system.
SunStone can assist hospitals develop processes to assess the Pharmacy pricing formulas to determine if current patient prices recognize all appropriate costs while maintaining consistency with the market and overall pricing strategy for the organization.
Managing the Pharmacy CDM Since drugs are typically purchased in bulk and dispensed in quantities that do not conform to the HCPCS units, facilities must establish the proper units within their CDM. In addition, ensuring that the CDM contains all applicable HCPCS for drug dosages can positively impact the net revenue.
SunStone dedicates time to compliance issues as well, specifically, Self-Administered drug regulations, and other newly issued drug regulations. Being compliant mitigates risk and ensures that you recoup costs related to services rendered.
First DataBank Average Wholesale Price (“AWP”) Conversion Effective September 26, 2011, First DataBank, Inc. has announced it will no longer publish the Blue Book Average Wholesale Price (“AWP”). SunStone assists hospitals review, revise and implement markup factors and formula’s as they transition to an alternative cost basis to calculate its patient prices. The objective is to establish patient prices that recognize appropriate costs within the pricing formulas while maintaining consistency with the local market and overall pricing strategy for the organization.
For detailed information about SunStone Consulting Pharmacy Revenue Cycle Solutions, please contact vondamoon@sunstoneconsulting.com ).
