• Revenue Enhancement
  • Coding & Compliance
  • HIM
  • Knowledge

Synchronize Disparate Chargemasters for Consistent, Accurate and Compliant Coding and Charge Capture

CDM synchronization may sound complicated, but standardization is necessary for a compliant charge capture process... Read more

Hospitals Nationwide Want to Establish Bundled Charges: CLAIMSauditor.com and Consultants Can Help

If you need to calculate charges by DRG and by surgical procedure or to propose discounted bundled charges for patient estimates... Read more

June–December is Good Time to Implement Your Defensible Hospital and Physician Pricing Strategy

The pressure is on for providers to establish prices that more closely align with cost... Read more

OIG Cites Medicare Overpayments of $6.7 Billion for E/M Services; CMS to Analyze Overpayments for Errors

The errors identified occurred due to coding issues and insufficient documentation, requiring physician education... Read more

2014 Radiology Coding Confusion: Remain Compliant and Capture Revenues With Bundled Codes

Pertinent changes in the 2014 CPT® code set require radiology practices to revise computer systems and charge sheets... Read more

Irrational Drug Prices Being Charged by Hospitals Continue to Surprise Patients

Time Magazine’s article "Bitter Pill: Why Medical Bills Are Killing Us” includes examples of irrational charges for drugs... Read more

ICD-10 Delayed Again………What Should We Be Doing in the Interim?

Most healthcare experts are still confident in the benefits of ICD-10. How can you not lose your momentum... Read more

DRGcheck.com Perfect Fit for ICD-9/ICD-10 Dual Coding, ICD-10 Readiness or Other Audit Initiatives

Determine the actual impact in reimbursement of going from ICD-9 to ICD-10 based on those cases audited or dual coded... Read more

Do Your Current Documentation and Coding Practices Support the Severity of Illness and Risk of Your Patients?

As you continue to work on ICD-9 MS-DRG audits, prepare... Read more

Coding Accuracy

Get the updated coding information you need with at-a-glance tables, concise explanations, quick tips and other timesaving features with publications and education from MedLearn Publishing... Read more

Recovery Auditor Compliance

Facilities serving Medicare and Medicaid patients look to RACmonitor for news, views and insight with bi-weekly e-news, alerts, special bulletins and our popular, live 30-minute podcast, Monitor Monday... Read more

Ease the Transition to ICD-10

ICD10monitor.com’s enewsletter and weekly podcast, TalkTenTuesday, cover topics such as coding and clinical documentation improvement, physician education, revenue cycle management... Read more

Hospitals Nationwide Prevent Overpayments and Capture Compliant Pharmacy Revenue with PHARMauditor

Hospitals nationwide are being targeted for noncompliant Medicare outpatient pharmacy billing practices. Each month, audits by the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) routinely create the demand for repayments of hundreds of thousands of dollars – and sometimes millions – for billing errors caused by hospitals reporting incorrect codes, billing units or both. These errors occur easily because of the sheer number of drugs used in the hospital setting and the complexity of Medicare coding and billing requirements, which often addressed are addressed inadequately by information systems and processes in place.

As a result, hospitals in more than a dozen states – including Arkansas, Arizona, California, Florida, Illinois, Minnesota, Montana, North Dakota, New Jersey, Massachusetts, New York, Ohio, Virginia and Washington – have turned to PHARMauditor as the preferred automated solution to simplify compliance with Medicare reporting requirements for drugs. With PHARMauditor, clients simply upload their current charge description master (CDM), pharmacy formulary data and usage statistics at the service code, patient type and payer plan code level to www.PHARMauditor.com. PHARMauditor compares hospital data with information in an extensive, validated, multi-source drug database and creates benchmark reports that instantly identify potentially noncompliant coding, billing unit management and reporting. Combined with expert Panacea chargemaster consulting support offered at no additional cost, hospitals are able to evaluate and correct errors in a fraction of the time required when using traditional manual or semi-automated review methods.

In one of many successful applications, a hospital in the Midwest used PHARMauditor as part of its annual chargemaster review and discovered that approximately 31 percent of reported HCPCS codes and related billing units were incorrect, invalid or incomplete. To ensure compliance with Medicare billing requirements, the hospital’s chargemaster managers are taking advantage of the precise mapping logic PHARMauditor provides to verify that the correct codes and billing unit assignments are accurate, now and in the future.

In another instance, a large Eastern regional medical center used PHARMauditor to evaluate past and current risks related to Recovery Audit (RAC) and OIG investigations. Because PHARMauditor allows users to analyze large and changing data sets, it now is used on a continuous basis to monitor and update pharmacy billing data as part of the medical center’s compliance program.

PHARMauditor is also invaluable as an auditing tool to aid in transition to new billing system platforms. Recently, three hospitals used PHARMauditor not only to develop new pharmacy chargemasters, but to validate the accuracy of data in recently implemented billing systems. In each instance, the hospitals not only were able to mitigate overpayment risk due to coding and billing unit errors, but also to identify hidden issues related to incorrect pricing algorithms and improve regulatory compliance outcomes.

If you would like to learn more about how your hospital can use PHARMauditor to take your pharmacy billing compliance and revenue capture to a higher level of excellence, we invite you to visit us online at http://panacea.articulate-online.com/5560912883 for a free on-demand presentation.

About the Authors

Gary R. Fong, Pharm. D. is Senior Vice President of Panacea. Gary has been in healthcare for over 30 years and his experience has been in pharmacy administration, hospital administration, the pharmaceutical industry and for the past several years, healthcare revenue cycle management consulting and service.

Randy Wiitala, BS, MT(ASCP) is Vice President, Clinical Consulting Services – Pharmacy of Panacea. Randy’s areas of expertise include pharmacy, chargemaster, and lab reviews for coding and regulatory compliance and revenue assurance. He is co-lead on the development of Panacea’s PHARMauditor.com and MedLearnDrugCodes.com, Randy is a contributing author to variety of publications and electronic products that help providers maintain revenue streams and regulatory compliance for Laboratory and Pharmacy services. Contact Randy at 800-252-1578 x3405 or rwiitala@panaceahealthsolutions.com.