A Career Step Company
Chargemaster Contents CDMauditor® Coding and Compliance Module (ChargeAssist®)
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Chargemaster Audit Services
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CDM Synchronization for Health Systems
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PHARMauditor™ 6 Save Time While Ensuring Accurate and Compliant Pharmacy Revenue
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Hospital Zero-Base Pricing® 10 Key Benefits
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On both state and federal fronts, hospital chargemasters continue to be the focus of intense scrutiny—making it critical to employ charge description master (“CDM�) technology that can both ensure accurate coding and compliance and enable hospitals to defend and document chargemaster pricing at the line-item level.
CDMauditor® Coding and Compliance Module (ChargeAssist®) Maintain your chargemaster with ChargeAssist®, the coding and compliance module from our CDMauditor suite.
ChargeAssist® is a cloud-based Charge Management solution for both small and large enterprise organizations that combines CDM auditing, charge benchmarking, charge change workflow management, and regulatory resources in an integrated easy-to-use product. Partnering with Holliday & Associates, ChargeAssist® was developed from the ground up to redefine how hospitals manage their CDM. The ChargeAssist® module contains at an allinclusive annual fee: CDM Audit Suite™ reinvents the audit process for annual and ongoing CDM maintenance. Price Analyzer™ assists in the assessment of existing line item prices. Change Monitor™ resolves CDM Management’s biggest challenge— automating user collaboration and documentation of charge changes. Ultimate Research Center™ is a single source coding and regulatory resource, providing cost savings on expensive third party resources, and ensuring smarter staff. Our innovative, next-generation system is built on a platform critical for today’s complex EMR’s, while at the same time allowing for excellent performance with all vendor systems. Users receive e-mail alerts, ongoing support from Panacea chargemaster consulting experts, automated workflow tools, continual change analytics and ready-to-access regulatory information tailored to the services performed in your clinical departments. CDMauditor’s comprehensive chargemaster maintenance and strategic pricing suite also includes the following modules: Hospital Zero-Base Pricing®, Comparative Health Data™, Unit Cost Estimator™, PHARMauditor.com™, PhysicianPricing.com™ and CDMsync™
*H FMA staff and volunteers determined that this product has met specific criteria developed under the HFMA Peer Review Process. HFMA does not endorse or guarantee the use of this product.
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Chargemaster Audit Services Our chargemaster audit services are unique. We provide more options and more services to meet your needs. Our team utilizes state-of-theart web-based technology to analyze and benchmark your data against current coding guidelines.
We’ll provide a summary scorecard that leads to actionable recommendations on deficiencies. And, unlike other firms, our team will recommend coding, compliance and pricing improvements, assist you in making them and even provide you with web-based access to our system for a sufficient time afterwards at no additional cost. We do this because we care and want our team to monitor and ensure the successful implementation of the recommended changes.
SCORECARD SERVICE LINE REVIEWED
CDM CODING ACCURACY
CDM CHARGE APPLICATION
CHARGE CAPTURE EFFECTIVENESS
We provide results in three functional categories:
LABORATORY
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CDM Coding Accuracy
INTERVENTIONAL RADIOLOGY
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CDM Charge Application
CARDIAC CATH
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Charge Capture Effectiveness
RADIATION ONCOLOGY
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SURGERY
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EMERGENCY ROOM
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REHABILITATION SERVICES
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Reduce the potential of denials, fines and audits
RESPIRATORY THERAPY
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Leverages expert talent and computerized systemss
WOUND CLINIC PAIN CLINIC
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MATERIALS MANAGEMENT
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CHEMOTHERAPY
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ENDOSCOPY OBSERVATION/ PATIENT CARE FLOORS OB
PHARMACY
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We provide results in three functional categories: Appropriately capture revenue Reduce errors that result in rejected claims Ensure there are no inappropriate reimbursements Confirm no missing charges
Process is sufficient/pass Insufficient/Process needs improvement
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CDM Synchronization for Health Systems Synchronize Disparate Health System Chargemasters or Clinical Systems with CDMsyncTM
Often, as a result of acquisitions or mergers, health systems find their organizations in the predicament of charging dramatically different prices and using inconsistent codes and descriptions for like services among their entities. This not only creates public relations issues but also makes it difficult to manage and provide vital reports from their decision support systems. A typical engagement for CDMsyncTM involves uploading the disparate CDM’s where the system will proceed to match like items or group seemingly like items from which a Panacea consultant or someone on your team will then utilize an innovative drag and drop feature to finalize and create a master CDM across the health system entities. Inconsistent pricing and coding within the same organization can lead to undesirable allegations or actions by consumers, regulators or payors and compromise data integrity. With our proprietary CDMsyncTM system, we’ll upload the charge description master (CDM) for each entity within your health system and analyze the data to flag inconsistent service codes, descriptions, HCPCS codes, revenue codes, and prices for like services and/or line items. The system automatically proposes the most predominately used codes across entities and calculates weighted average prices to assist users in developing consistent coding and pricing. You can also utilize this CDMsyncTM feature to align your CDM with departmental clinical systems!
CDMsync™ across the health system will: Develop a corporate CDM or common CDM across entities Find missing codes and make assignments as appropriate Find and correct for inconsistent codes, descriptions and prices Improve public relations & data integrity Reduce risk of adverse action Ensure optimum and consistent coding and reimbursement Synchronize CDM and clinical systems
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PHARMauditor™ PHARMauditor.com, Panacea’s cloud-based software tool, can be used to maintain accurate pharmacy coding, compliance and reimbursement. Our system automatically performs a comprehensive assessment to provide the information you need to ensure accurate and correct revenue codes, HCPCS/CPT codes, billing units, NDC descriptions, Average Wholesale Pricing (AWP) and Wholesale Acquisition Cost (WAC). Are you wondering whether you are appropriately capturing your pharmacy revenue and properly billing and reporting and want to know for sure? Find out with PHARMauditor.com. This web-based tool performs a comprehensive review and flags drugs having potentially improper or missing revenue codes, HCPCS/CPT codes, billing units, national drug codes (NDCs), descriptions and pricing. The system: Improves pharmacy revenue capture and data integrity Aligns mapping between pharmacy system and CDM Ensures that proper HCPCS and revenue codes are assigned for all NDCs Assists with ensuring that correct descriptions and dosages are in CDM and formulary Maintains current and valid NDC numbers Ensures accurate billable units, package size and package quantity for NDC Flags potentially too high or low current price mark-ups relative to AWC and WAC cost Reduces your RAC risk Provides access to DrugCodeLookUp.com at no additional cost for quick searches by drug name (brand or generic), HCPCS or CPT code, NDC number, ICD-9-CM code or Therapeutic Class
Our consultants are always available to assist in interpreting the results, implementing the changes and to work with your hospital IT department to migrate the pharmacy data file directly into your pharmacy chargemaster.
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Save Time While Ensuring Accurate and Compliant Pharmacy Revenue With Panacea’s Pharmacy Revenue Improvement solution, not only will your formulary and chargemaster be accurate and up-to-date, but you will also have defensible, best-practice drug pricing that minimizes coding and billing risks.
A Complex System As a leader in the hospital pharmacy, you juggle the complexities of almost daily reimbursement rule changes and skyrocketing drug prices. Panacea’s expert team can help: Help to integrate pharmacy data Updating the formulary Auditing and generating reports on a regular basis Ensuring you have the power to hunt down lost revenue Finding gaps in pharmacy data as it moves through disparate billing systems or has been “standardized” through an EHR Converting dosed or dispensed drug amounts to billable units as easily as possible The pressure to balance these elements is constant. To help you stay on top of it all and initiate, support, or expand your pharmacy’s Revenue Integrity Program, Panacea can work with you on these common issues: Mapping of NDC, HCPCS, revenue codes, and billable units Validating documentation of drugs ordered, dispensed and administered, and billed Identifying the appropriate defensible pricing methodology for mark-up Ensuring more accuracy to decrease claim rejections due to errors
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Pharmacy Revenue Improvement Solution Panacea combines industry experts with sophisticated analytic software to alleviate the pressures of limited resources and pharmacy revenue loss by bringing in the right experts using software they themselves helped create. Panacea has helped hundreds of pharmacies and can bring that experience to you. 1. A Panacea consultant will conduct a documentation review and comprehensive analysis to uncover any coding and billing risks. Our consultant will focus on your charge capture processes and pharmacy chargemaster using its PHARMauditor™, Panacea’s cloudbased software tool. This industry expert validates accurate charge capture, coding, claims processing, and receipt of accurate payment so that you do not miss charges or have incorrect billing units. Panacea will also evaluate reimbursement and denial patterns identified during the documentation review. 2. Your Panacea expert will complete a formulary review to check for coding compliance and appropriate pricing. They will use PHARMauditor with its extensive database of current NDC numbers to accurately code map HCPCS, revenue, billable unit, AWP or WAC cost. This one-time pharmacy formulary cleanup ensures that codes and costs are current and correct.
The Complexity of Pharmacy Pricing As an example of how complex pharmacy pricing can be, consider BENLYSTA, an intravenous drug available in a 120mg per 5mL single-dose package and a 400mg 20mL single-dose.
KEY BENEFITS Uncover coding and billing risks Reveal new incremental revenue opportunities Update and maintain accuracy and data integrity Formulary Chargemaster or other charge data file Decision support systems
Selecting the correct unit when billing is critical because price depends on the dose given and the cost of each vial. For example, consider a 360mg dose given April 5, 2017. If the NDC for the 400mg/20mL package is used the cost is $1,992.02. However, only 18mL is used, creating waste of 2mL with a cost of about $200 for this single patient dose. Although perhaps counterintuitive, using 3 vials of the 120mg/5 mL would cost the same without the need to waste $200 worth of medication. Ensuring accurate reporting of waste and tracking reimbursement adds one more layer of complexity to pharmacy billing. Panacea’s experience in the complexities of pharmacy pricing and our PHARMauditor tool facilitate a comprehensive review and assessment of coding compliance. With us, you will be able to assess and maintain an accurate pharmacy charge description master, formulary, and coding and billing compliance.
Create rational and defensible best-practice drug pricing Reduce risk for RAC and OIG audits
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Getting Started Is Easy In our experience, pharmacies that have between 4,000 to 5,000 medications can complete the process and have accurate coding and compliant, defensible pharmacy pricing in just 3-6 months. With the following from you, we have everything needed to begin your document review and analysis: Charge description master (CDM) Drug formulary data Hospital list Department list Usage data at the NDC level Any special data specifications if you have dynamic information systems Access to select medical records for review of medication orders eMAR Nurse documentation of administration Detail itemized bill Remittance advice from payor(s)
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Hospital Zero-Base Pricing® In this era of intense public scrutiny, Panacea provides a proven cost and market-based strategy that delivers the pricing discipline the market demands while achieving your net revenue objectives.
Clearly the most defensible price is one that is based on actual cost. Over the decades with many hospitals being reimbursed or paid less than cost by federal and managed care payers, shortfalls were subsidized through selective price adjustments or cross-subsidization. After years of deploying such techniques, hospital administrators are found today in an era of intense public price scrutiny with chargemasters incredibly difficult to explain. The Hospital Zero-Base Pricing® program establishes prices based on actual unit costs and provides comparisons to local peer’s prices. Where needed, we use sophisticated software and analysis to estimate unit costs. This saves the burden and expense of implementing a traditional cost account system. Before finalizing price models, some prices are adjusted to ensure that the cost-based prices don’t fall below contractual amounts and that others remain competitive. You also receive net revenue models for multiple pricing scenarios and a comprehensive audit trail for each line item. In short, you have exactly what you need to defend your pricing.
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Key Benefits
Prices can be established based on a hybrid of unit cost, multiple market groups, fee schedules and other parameters to be rational and defensible
Maintains your net revenue objectives
Considers medicare and non-medicare, APC rates, and fee schedules
Pricing is competitive and defensible
Cost accounting system is not required
Multiple pricing scenarios presented
Provides audit trail for future reference
For more information, call us at 866-926-5933 or register for a free on-demand demonstration at panaceainc.com.
*H FMA staff and volunteers determined that this product has met specific criteria developed under the HFMA Peer Review Process. HFMA does not endorse or guarantee the use of this product.
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A Career Step Company
Panacea Healthcare Solutions, Inc. is a Career Step Company Career Step is an Inc. 5000 company with total revenues of $64M and over 160 employees across offices in Minnesota, New Jersey, Florida and Utah. Career Step manages Panacea Healthcare Solutions, Inc., as an independent brand and entity within the Career Step Professional Training division.
Minnesota
New Jersey
Utah
Panacea®
Panacea®
Panacea®
444 Cedar Street
595 Shrewsbury Ave
2901 N Ashton Blvd
Suite 920
Suite 201
Lehi, UT 84043
St. Paul, MN 55101
Shrewsbury, NJ 07702
Ask about Panacea’s HFMA peer-reviewed solutions – Hospital Zero-Based Pricing, ComparativeHealthData.com and Unit Cost Estimator. *HFMA staff and volunteers determined that this product has met specific criteria developed under the HFMA Peer Review Process. HFMA does not endorse or guarantee the use of this product.
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