ATLANTA, June 3, 2013 /PRNewswire/ -- The Centers for
Medicare & Medicaid Services (CMS) Recovery Audit Program is
targeting hospital billing patterns for outpatient drugs and its
audits have called into question millions of dollars in potential
overpayments. To help hospitals mitigate the serious pharmacy
compliance and revenue risk of overpayments, and to help identify
underpayments, Craneware, Inc., the healthcare market leader in
automated revenue integrity solutions, which pioneered technology
for verifying pharmacy data in 2008; today announced that it will
showcase its advanced Pharmacy ChargeLink® innovation at the
American Society for Health-System Pharmacists® (ASHP) 2013 Summer
Meeting and Exposition to be held June 1-5,
2013 in Minneapolis,
Minn.
(Logo: http://photos.prnewswire.com/prnh/20121221/CL33999LOGO
)
One of the opportunities emerging from the Affordable Care Act's
(ACA) focus on transparency is for healthcare leaders to establish
a process for pharmacy revenue integrity and data governance across
their hospitals and clinics. Widely used drugs, including
Herceptin, Remicade and Lupron, are being targeted by recovery
auditors (RACs), with strict consequences if claims are not
accurate.
"Craneware solutions help hospitals be prepared to successfully
defend their earned revenue in an audit and as part of this process
we study the focal points that RACs are targeting," commented
Craneware COO Derek Paterson. "More
than half of the issues being targeted by recovery auditors are
pharmacy related. Key among hospital pharmacy's vulnerabilities are
questions about the medical necessity of drugs being dispensed and
related documentation, incorrect HCPCS coding, and hospitals
billing entire vials when they are deemed multi dose and should be
billed as dispensed quantity only. Pharmacy ChargeLink helps
identify these potential issues from purchasing data as well as
formulary and chargemaster data, and informs on how to bill
correctly and avoid the risks of audits."
Underpayments continue to be a significant, largely hidden
problem, from HCPCS coding issues to billing units and charge
capture issues, it's hard to identify these losses without bringing
both data sets together and looking at exceptions. Typically
all that a pharmacy sees is a chargemaster service code, and they
do not know what information that service code relates to in the
chargemaster. Craneware is identifying large discrepancies
between what pharmacies think is being billed and what is really
being submitted for payment.
"One of the tool's most compelling findings was the volume
reconciliation variance between our drug spend alongside revenue
and usage data," said Kathy Lytal,
Parkview Health's director of revenue integrity. "We identified an
annual gross revenue variance in excess of $10 million. Pharmacy ChargeLink provided an
environment to manage by exception, supporting our ability to
clearly identify the individual drugs that were contributing to the
variance, and prioritize our process improvement initiatives.
Parkview held a Rapid Improvement Event, engaging key clinical
stakeholders to identify root causes and develop improved charge
capture processes. Identifying the specific sources of the leakage
was an incredible value, allowing the team to focus on the process
and execute action plans in the responsible areas," Lytal
explained.
"Today, healthcare organizations of all sizes must look closely
at their pharmacy data and validate its accuracy," said Craneware
CEO Keith Neilson. "Many health
systems don't realize the sizeable underpayments that occur when
they manually manage the numerous points of contact between
purchasing, medication-administration, and reimbursement. Data can
be lost or degraded anywhere along that path. To enable hospital
organizations to efficiently realize the value inherent in the
validation of their pharmacy charges, Craneware pioneered an
automated solution that supports a proven data governance process
for ensuring the accuracy and integrity of pharmacy data."
Technological integration between hospital, clinic and pharmacy
solutions has been rare in the past. Most hospitals struggle to
link purchase history data to reimbursement activities and continue
to use manual methods such as spreadsheets to manage reviews
annually, during which time revenue loss is compounded. Craneware's
Pharmacy ChargeLink software helps healthcare organizations align
their pharmacy data across hospitals and clinics, and solve the
complex issues inherent in this reconciliation that are unique to
pharmacy. Manual processes represent significant vulnerabilities in
charge capture. Having technology to analyze the calculations
between purchased billable units and billed units easily pinpoints
areas to re-capture compliant revenue. While this seems relatively
intuitive, hospital system reporting and analytics between
formulary procurement and revenue integrity do not provide
transparent integration for audit and review. These challenges
require automated solutions in order to mitigate compliance risk
and achieve earned reimbursement for one of the most costly
supplies in healthcare.
About Craneware
Craneware (AIM: CRW.L) is the leader
in automated revenue integrity solutions that improve financial
performance for healthcare organizations. Craneware's
market-driven, SaaS solutions help hospitals and other healthcare
providers more effectively price, charge, code and retain earned
revenue for patient care services and supplies. This helps
customers optimize reimbursement, increase operational efficiency,
minimize compliance risk, and retain more earned revenue. By
partnering with Craneware, clients achieve the visibility required
to identify, address and prevent revenue leakage. To learn more,
visit craneware.com and stoptheleakage.com.
SOURCE Craneware, Inc.