PHARMauditor
TM
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-10-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. For more information, call us at 866-926-5933 or register for a free on-demand demonstration at panaceainc.com.
Ensure Pharmacy Revenue is Accurate, Defensible, and Compliant Making sure your pharmacy revenue cycle is accurate, defensible, and compliant can be complex due to a host of intricacies: Incorrectly mapped NDC, HCPCS, revenue codes, and billable units Inconsistencies related to amount of medication dispensed and billed Lack of informed methodology around cost versus mark-up Increased likelihood of claims rejected and audits due to errors
The Pharmacy Revenue Improvement Solution Panacea combines industry experts with sophisticated analytic software to help detect and correct these issues and help you implement best practices. 1. A Pancacea consultant conducts a documentation review and comprehensive analysis to uncover any pricing inconsistencies and coding and billing risks. Our consultant focuses on your charge capture processes and pharmacy chargemaster with PHARMauditor™, Panacea’s cloud-based software tool. Your Panacea industry expert will also validate accurate charge capture, coding, claims processing, and receipt of accurate payment, ensuring you do not miss charges or have incorrect billing units.
2. Your Panacea expert will complete a formulary review to check for coding compliance and appropriate pricing. They will use PHARMauditor’s extensive database of current NDC numbers to accurately code map HCPCS, revenue code, billable unit, AWP or WAC cost, and reimbursement. This one-time pharmacy formulary cleanup ensures codes and costs are current and correct.
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
Access to select medical records for review of medication orders
Hospital list
eMAR
Department list
Nurse documentation of administration
Usage data at the NDC level
Detail itemized bill
Any special data specifications if you have dynamic information systems
Remittance advice from payor(s)
The Complexity of Pharmacy Pricing As a example of how complex pharmacy pricing can be, consider BENLYSTA, an intravenous drug available in a 120 mg per 5-mL single-dose package, and a 400 mg 20-mL single-dose. Depending on the dose given, and the cost of each vial, selecting the correct unit when billing is crucial. Benlysta 120 MG SOLR (J0490) AWP (Average Wholesale Price) Pricing NDC
Price Effective Date
AWP/Unit (mL, Tab, etc.)
Package Size
AWP/Pkg Size
Package Qty
AWP/Pkg Qty
49401-0101-01
04/01/17
$597.62000/EA
1.00 EA
$597.62/Vial
1 Vial
$597.62
49401-0101-01
10/01/16
$590.24000/EA
1.00 EA
$590.24/Vial
1 Vial
$590.24
Uncover coding and billing risks
49401-0101-01
12/18/15
$581.52000/EA
1.00 EA
$581.52/Vial
1 Vial
$581.52
Reveal new incremental revenue opportunities
49401-0101-01
06/30/15
$572.93000/EA
1.00 EA
$572.93/Vial
1 Vial
$572.93
49401-0101-01
12/19/14
$564.46000/EA
1.00 EA
$564.46/Vial
1 Vial
$564.46
49401-0101-01
07/01/14
$556.12000/EA
1.00 EA
$556.12/Vial
1 Vial
$556.12
Key Benefits
Update and maintain accuracy and data integrity - Formulary - Chargemaster or other charge data file
Benlysta 400 MG SOLR (J0490) AWP (Average Wholesale Price) Pricing
- Decision support systems Create rational and defensible best-practice drug pricing Reduce risk for RAC and OIG audits
NDC
Price Effective Date
AWP/Unit (mL, Tab, etc.)
Package Size
AWP/Pkg Size
Package Qty
AWP/Pkg Qty
49401-0102-01
04/01/17
$1,992.02000/EA
1.00 EA
$1,992.02/Vial
1 Vial
$1,992.02
49401-0102-01
10/01/16
$1,967.44000/EA
1.00 EA
$1,967.44/Vial
1 Vial
$1,967.44
49401-0102-01
12/18/15
$1,938.36000/EA
1.00 EA
$1,938.36/Vial
1 Vial
$1,938.36
49401-0102-01
06/30/15
$1,909.72000/EA
1.00 EA
$1,909.72/Vial
1 Vial
$1,909.72
49401-0102-01
12/19/14
$1,881.49000/EA
1.00 EA
$1,881.49/Vial
1 Vial
$1,881.49
49401-0102-01
07/01/14
$1,853.69000/EA
1.00 EA
$1,853.69/Vial
1 Vial
$1,853.69
Panacea’s experience helping unravel the complexities of pharmacy cost and pricing using our unique PHARMauditor tool will facilitate a comprehensive evaluation of your pharmacy revenue cycle. With us, you will be able to assure consistency, compliance and transparency of pricing, helping the pharmacy department’s bottom line.
For more information, call us at 866-926-5933 or request information at panaceainc.com
Minnesota
New Jersey
Panacea® 444 Cedar Street Suite 920 St. Paul, MN 55101
Panacea® 1707 Atlantic Avenue Building 1, Suite 4 Manasquan, NJ 08736
Ask about Panacea’s HFMA peer-reviewed solutions – Hospital Zero-Base 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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