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A New Look at Pharmacy Integrity: Is Your Volume Reconciliation Lost in Translation?

Does your hospital have a process to ensure that medication doses administered are correctly converted into billable units? This calculation is tricky. It involves the amount of the drug purchased, the dose administered, and the units of measure that are allowed as billable by the payor.

Medicare looks at hospitals’ cost reports to see if hospitals are billing for more drugs than purchased. If it looks like they are, then recovery auditors will check it out.

There is greater focus around pharmaceuticals and their use today. An April 15, 2014 study, reports that total U.S. spending on medicines increased 1.0 percent on a real per capita basis in 2013, while the use of healthcare services overall rose for the first time in three years. The study – Medicine Use and Shifting Costs of Healthcare: A Review of the Use of Medicines in the United States in 2013 published by IMS Institute for Healthcare Informatics – found that,  “total dollars spent on medications in the U.S. reached $329.2 billion last year, up 3.2 percent on a nominal basis and a rebound from the 1.0 percent decline in 2012.” Also, “Overall utilization of healthcare services grew slightly as consumers returned to the healthcare system – primarily through more office visits to specialist physicians as well as outpatient treatments – following several years of self-rationing.”

Attend the Craneware Benchmark Series: Key Indicators of Revenue Integrity Excellence to understand how well your organization is performing against Craneware standards and, equally importantly, gather step-by-step best practices to minimize compliance risk and optimize financial performance.

What steps has your hospital or health system taken to ensure pharmacy revenue integrity?