Our Executive Clinical Pharmacy team talks through strategies for maximum revenue capture at a time when hospitals are trying to keep up with COVID-19 related admissions, while seeing less revenue coming in from elective procedures and changes to the 340B program are looming.

Topics included in this episode:

  • Revenue Capture Strategies

    • Pharmacy Teams 

    • Revenue Cycle Management Teams 

  • 340B Program Background

    • Pricing and Margin Implications 

    • Recent Changes 

    • Pass-through and Non-pass-through

    • Biosimilars 

    • Drugs with No ASP Pricing

    • Exemptions

    • Litigation 

  • Potential Changes for 2021 

 

IPD'S DRUG & CLINICAL REVIEW:

PROVIDER STRATEGIES FOR MAX REVENUE CAPTURE

"Well, these groups have been taking advantage of our weekly data files and pricing updates. Information updated in this fashion allows them to effectively reconcile claim payments based on date of service, ensuring appropriate reimbursement is being provided as per their contract. Also, our not-otherwise-classified, or NOC, guides can be of assistance as the number of new drug approvals begins to escalate. As new drugs are approved and are not yet assigned a specific code, billing requires the use of not-otherwise-classified codes, and billing for these drugs can be confusing and difficult, which leads to potential errors and underpayment for these drug products. And finally, I think the goal for every hospital billing department is to minimize claim rejections and the associated costs of resubmitting those claims. This can be minimized if you have all the correct coding information, including the correct billing units, the max dose information, ICD-10-CM information and related drug administration code information, which can easily be found on the platform."

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