Our comprehensive initial assessment will capture, analyze and maximize any possible areas for reduction in drug costs and capture of additional revenue through Formulary Review, 340B options and charge capture.
Charge Capture and Billing
Accurate charge capture and clinical documentation and coding will simplify the billing process which should reduce denials and shorten the days in accounts receivable. Capturing charges for all delivered services gives hospitals and practices the ability to improve revenue management, reduce lost charges, and reduce their billing cycle time.
Successful inventory management involves balancing the costs of inventory with the benefits of inventory. We need to ensure that we have the medication for our patients but many managers fail to appreciate the true costs of carrying inventory, which include not only direct costs of storage, but also the cost of money tied up in inventory.
Drug Expense Review and Reporting
Accurate reporting of drug expense is a critical component in understanding drug utilization and appropriateness of therapy. Benchmarking of data between different institutions provides an understanding of current practices and identifies potential opportunities for improvement.
Drug Utilization Review
A method of evaluating and re-examining the use of drugs in order to determine the appropriateness of the drug therapy. Proper drug utilization is a key component to controlling and reducing drug expense.
Drug Formulary Management
A listing of medications that have been selected to be used by the health-system. Drugs may be included on a drug formulary based upon their efficacy, safety and cost-effectiveness. Selection of medications allows for proper utilization, appropriate inventory and cost effectiveness. Management of the drug formulary is a critical component of the medication management process.
Disproportionate Share Hospitals (DSH)
The United States Government provides special funding to hospitals who treat significant populations of indigent patients through the Disproportionate Share Hospital (DSH) programs. The program seeks to continue to encourage hospitals to provide health services for these individuals. There are DSH programs for both Medicare and Medicaid as well as a program for pharmacies, known as the 340B program. Hospitals have the ability to drastically reduce medication costs if they qualify as a DSH Hospital.
340B Drug Pricing Program
The federal 340B Drug Pricing Program provides access to substantially reduced price for prescription drugs to care facilities certified by the U.S. Department of Health and Human Services (HHS) as “covered entities”. These clinics, centers and hospitals in turn serve more than 10 million people in all 50 states, plus commonwealths and territories. Hospitals have the ability to drastically reduce medication costs if they qualify as a “covered entity”.
Group Purchasing Organizations (GPO )
A group purchasing organization (GPO) is an entity that helps healthcare providers such as hospitals, nursing homes and home health agencies – realize savings and efficiencies by aggregating purchasing volume and using that leverage to negotiate discounts with manufacturers, distributors and other vendors. Most hospitals belong to a GPO, but many fail to take advantage of the savings.
Retail pharmacies provide needed revenues that directly reflect the value of the hospital’s core clinical services. They improve customer satisfaction and create a competitive advantage for hospitals and physician providers.
All findings and comments are documented. A final written report is presented to the client within 30 days after the on-site assessment. The focus of the report is provide both short and long term cost saving opportunities and provide cost effective and efficient solutions that address drug expense and revenue enhancement.