At the Margins

Does your pharmacy know the ins and outs of finance? How a specialist can cut billing errors.

by Robin Brand and Sophia Duke-Mosier

What if an organization had a pharmacist dedicated to revenue integrity? The pseudonymed Beesly Health has just that—and it's helped the organization considerably reduce its billing errors.

Before hiring a pharmacy revenue integrity specialist, Beesly discovered a billing error that cost the organization $6 million in underpayments and denials. Given the size of this opportunity, the Director of Finance and VP of Finance advocated for a pharmacist who understood the ins and outs of both pharmacy and finance to work with pharmacy-related charges.

How Beesly's specialist elevated pharmacy revenue

Beesly Health's pharmacy revenue integrity specialist has been highly successful, focusing on front-end work flows to improve charge capture. In addition, the specialist has maintained the pharmacy chargemaster to not only reduce billing errors, but improve organizational buy-in as well. For each drug the specialist re-bills, the organization saves between $13,000 and $80,000. In addition, the specialist has done work around medically unlikely edits, resulting in considerably higher net revenue per-drug per-patient on claims that have been previously written off.

On top of that, the specialist has taken monthly meetings to the next level. In our research, we've heard a lot about regular workgroups that meet to combine the expertise of IT, revenue integrity, and clinical departments to solve problems. At Beesly Health, these meetings are focused solely on pharmacy, making them all the more efficient. The meetings include front- and back-end revenue cycle and pharmacy stakeholders, allowing for robust discussion and comprehensive solution implementation.  

While hiring a dedicated service line specialist comes at a cost, Beesly Health has found it to be highly successful and is currently adding more service line specialists starting with cardiology, ED, medical authorization, and radiology.

 

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6 ways your pharmacist can reduce costs and improve quality

From improving medication adherence to reducing hospital-acquired infections, pharmacists can play a significant role in critical organizational goals.

Our infographic outlines six pharmacist-led practices that can help improve patient outcomes and reduce overall health care spending. Download it now to get details about each practice, examples of how your peers put them into action, and the resulting impact on quality, safety, and cost reduction.

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