Challenge

In a not-for-profit hospital environment focused on delivering high quality care to patients, all departments at Firelands Regional Medical Center were seeking ways to save money and optimize revenue. Because its chargemaster was out-of-date, the pharmacy struggled to make significant changes because there was no efficient way to verify whether charges were accurate. Like many health care facilities, prices were adjusted by across-the-board percentage increases rather than based on actual costs. Progress was further inhibited because the pharmacy and revenue cycle management lacked a shared platform to address cross-departmental issues.

Solution

Pharmacy ChargeLink®, Chargemaster Toolkit®, Bill Analyzer, Online Reference Toolkit

Results

• Identified net revenue of $2 million ($6 million gross) in uncaptured charges over an 18-month period with a focus on pharmacy and oncology.
• Identified net revenue of $850,000 ($2.2 million gross) after a cost-to-charge review, removing outdated drug acquisition costs and updating to actual costs and markup.
• Addressed incorrect multipliers and HCPCS coding issues, identified missing charges, and deactivated out-of-date charges.
• Aligned consistent pricing to decrease disparities in drug charging between inpatient units and cancer center, increasing patient satisfaction.
• Helped the hospital form a cross-functional team that continues to improve revenue integrity and compliance across pharmacy and finance.