With rising drug costs and decreasing reimbursements contributing to shrinking margins (in 2014, according to Modern Healthcare, 61.3 percent of healthcare providers reported decreased margins from the previous year), hospitals continue to scrutinize their revenue cycles to ensure they stay in the black, and there’s an oft-overlooked resource they would do well to consider: pharmacy. Historically, the hospital pharmacy has been labeled a cost generator, but there are actually many ways this strategic department can positively impact each stage of the revenue cycle – from point of service to claim submission and more. This webinar will explore innovative tactics, including optimized processes, improved data management, and creative patient programs, which hospital pharmacies across the country can leverage to boost overall hospital revenue.

1. 5 Ways Your Pharmacy Can Boost Your
Revenue Cycle
November 3, 2016

2. Speakers
2
Dana Fox
Program Development Manager
CompleteRx, Ltd
Justin Sotomayor, PharmD
Director of Pharmacy Informatics
CompleteRx, Ltd

3. 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
3

4. 4
Challenges
• Regulatory and market
changes
• Payor practices
• Technology

5. What is your biggest
revenue cycle challenge
today?
5
A. Regulations and market changes
B. Payor practices
C. Technology
Quick Poll

6. HOSPITAL
REVENUE CYCLE
A/R and Denial
Processing
Patient Registration and
Insurance Verification
Patient Exam and
Treatment Prescribed
Pharmacy Formulary
and Purchasing
Dispensing Transactions
and Informatics
Patient BillingPatient Assistance/Retail
Med Dispensing
Payment Processing
6

7. 5 Ways Pharmacy Can Impact Revenue
Cycle

8. 8
Patient Exam and Treatment
Prescribed
Patient exam
• Clinician exam
Treatment prescribed
• Inpatient impact areas
• Outpatient impact areas

9. 9
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

10. 10
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

11. 11
Patient Billing
Charge Description Master (CDM) updates
• Drugs constantly changing in price
• Regularly review/update CDM
• NDC updates
• Examples: Daraprim, Vasostrict ,EpiPen, Insulin
products

12. 12
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
reimbursement
Ampicillin/Sulbactam – Jcode of J0295
Billing unit = 1.5g
Payment allowance limit = $3.69/unit
or = $7.39/3g dose
$4,040.55 per
patient treatment
day (annually)

13. 13
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

14. Which initiative would
benefit your hospital or
health system most?
14
A. Clinical
B. Pharmacy Purchasing
C. Informatics/Technology
D. Patient Billing/CDM
E. Retail/Patient Assistance
Quick Poll

15. Questions?
completerx.com
Knowledgeseries@completerx.com