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Does Your Monthly Medication Payor Change Volume Make You Want to Medicate?


colleagues

How many commercial payors does your hospital work with? Now multiply that by 30; that’s how many pharmacy policy updates there are each month on average. If your monthly medication payor change volume can seem overwhelming – you’re not alone. So, what can you do?

On average, a commercial payor will have 30 pharmacy policy updates each month. Not staying up-to-date with these changes leads to delay in payment, loss of revenue and extra work for the back-end of the revenue cycle.

As healthcare continues to change and grow more complex, so do the challenges surrounding medications – authorization requirements, correct billing, medical necessity – and much more.

We all know that old saying, “time is money, money is time” – so it’s time for a new approach to distributing not only pharmacy updates – but all policy updates from payors.

Today, most policy updates are distributed through newsletters, meetings, blogs and even word-of-mouth which often results in a delay of knowledge and sometimes inaccurate information.

To aid in the curation of updates into one centralized location, consider developing a single point of origin tool. This promotes standardization through coded sources to reduce administrative time, educate associates efficiently and eliminate “noise.”

At Ensemble Health Partners, we’ve developed a system that uses tags to categorize, store and distribute policy updates to specific target audiences within the revenue cycle. Additionally, the system archives all supporting documentation, serving as a resource library. Associates can utilize the search function to locate specific updates and understand changes over time.

Once the system has been developed, it’s time to focus on how people use it. Most leaders see policy updates as passive information. However, we can promote action and accountability with this information to increase results. Our rules engine assigns the specific update to the appropriate associates. They can then log what actions they have taken or what actions still need to be performed. In this way, recipients are held accountable for implementing proactive measures. Of course, this is all logged in an audit trail, creating high visibility throughout the organization.

The Bottom Line – Driving Efficiency and Accountability Through Effective Policy Updates

At Ensemble, we broke industry norm and created a new way of impacting the revenue cycle. This tool has allowed us the opportunity to keep a single point of origin to curate this information and effectively distribute throughout the organization. Today, our healthcare systems are more efficient, effective and accountable when impacting the revenue cycle through new resources developed with the payor and patient in mind.

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John Hunter
Author: John Hunter

John Hunter is the Manager of Payment Integrity Analytics at Ensemble Health Partners. He has 5 years of Revenue Cycle experience and has created numerous workflow optimization resources and tools.