Building a Pharmacy Revenue Integrity Program
May 2017 - Vol. 14 No. 5 - Page #20

Extending beyond our traditional practice areas to influence strategic and transformative care delivery is within pharmacists’ DNA. Yet, our profession seems to remain relatively content operating within its conventional role. While the value of having a senior-level pharmacy leader at the executive table is undisputed, imagine the possibilities if pharmacy leaders acquired other senior level positions. One opportunity for pharmacy leaders to lean into and work collaboratively with other health system leaders is launching a revenue integrity program.

OhioHealth is a 10-hospital health system with 28,000 staff members, 50+ outpatient locations, and over $3.2 billion in net patient revenue. In preparation for a 2015 electronic health record (EHR) conversion across seven hospitals and numerous physician practice locations, our service line launched a pharmacy revenue integrity program. With annual hospital pharmacy gross revenue for these seven hospitals exceeding $600 million, ensuring proper fiscal management was a significant concern. The initial program goal was to test the hospital pharmacy charge description master (CDM) for coding accuracy and standardize pricing before EHR go-live to minimize post-implementation revenue disruption. The overarching purpose of the financial integrity program is to achieve complete, appropriate reimbursement by driving operational efficiencies and compliant processes.

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