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Published on: December 27, 2016
Uncovering pharmacy department risks and opportunities
Gary R Fong1, Randy Wiitala, Frederick Stodolak
1Panacea Healthcare Solutions, Inc., Scottsdale, Ariz, USA. gfong@panaceahealthsolutions.com
Summary
Hospital finance leaders must audit pharmacy billing and coding to identify risks from inaccurate National Drug Codes, Healthcare Common Procedure Coding System codes, and pricing. This proactive review ensures financial integrity and compliance in pharmacy operations.
Area of Science:
- Healthcare Finance
- Pharmacy Administration
- Medical Billing and Coding
Background:
- Improper billing, coding, and pricing for pharmacy items pose significant financial risks to hospitals.
- Accurate financial data is crucial for operational efficiency and regulatory compliance.
Purpose of the Study:
- To outline a method for assessing hospital financial risk related to pharmacy billing.
- To guide finance leaders in identifying specific areas of potential billing inaccuracies.
Main Methods:
- Conducting a comprehensive audit of the pharmacy department's charge description master.
- Reviewing accuracy of National Drug Codes (NDCs).
- Verifying Healthcare Common Procedure Coding System (HCPCS) codes, UB-04 revenue codes, billable units, and pricing (Wholesale Acquisition Costs and Average Wholesale Prices).
Main Results:
- The audit identifies specific discrepancies in pharmacy charge data.
- Potential financial losses due to billing errors can be quantified.
- Areas requiring immediate correction in the charge description master are highlighted.
Conclusions:
- Regular audits of the pharmacy charge description master are essential for mitigating financial risks.
- Accurate coding and pricing are critical for compliant and profitable hospital pharmacy operations.
- Addressing identified inaccuracies improves revenue cycle management and reduces compliance vulnerabilities.
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