Pharmacy: Identifying and Solving Problems in the Revenue Cycle

Pharmacy is always a source of concern for the revenue cycle. This department has significant costs associated with the medication purchase and very complex systems for dispensing and administration furthered by a billing requirement that does not match the pharmacy dispensed units. We will review the revenue cycle, the pharmacy solutions (i.e. Willow), pharmacy team impacts and the charge capture process. We will examine the CDM and multiplier as a root cause of leakage. This session will review some complexities like JW modifier and post claim submission audits by the payors. We will finally examine the impact of prior authorization and audit on the ultimate reimbursement.