Optimize Drug Reimbursement

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Pharmacy ChargeLink®

The revenue impact of using Pharmacy ChargeLink was nearly immediate. We discovered an increase of $1.5 million in gross revenue – per month – during the first six months.

– Kathy Huston, Charge Capture Coordinator, Hendrick Medical Center  

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Ever-rising drug costs and ever-changing regulations likely make it difficult for your organization to receive proper reimbursement for the pharmaceuticals it administers, with the problem complicated by gaps in data moving between the systems that manage pharmacy purchases and patient billing. When pharmacy reimbursement codes are absent, incomplete, or incorrect, reimbursement will be denied, lowered, or delayed, and your hospital may increase its compliance risk.

Pharmacy ChargeLink® solves these issues by ensuring that administered medications are accurately coded, billed, and reimbursed at an optimal level. By synching the drug purchase history and the chargemaster and addressing the gaps that cause revenue leakage, Pharmacy ChargeLink helps you identify revenue opportunities and create defensible pricing strategies. Its volume reconciliation tool compares the units purchased with the volume you've actually billed, to identify charge-capture problems and better manage potential compliance risks.

  • Pharmacy ChargeLink detects codable drugs that are missing from the chargemaster, and identifies problems with billing units and route of administration. It alerts you when Medicare payments may not cover costs and identifies drug charges that are misaligned with your pricing strategies.
  • Built-in workflow and change-management processes allow updates from pharmacy staff to be signed-off by reimbursement and pricing specialists. Recommended changes are integrated with the workflow approval process to increase efficiency and communication between pharmacy and finance staff.
  • Pharmacy ChargeLink connects to the Micromedex® RED BOOK™ database for information and pricing data on prescription drugs and over-the-counter medications. This enables your staff to perform alternative-drug searches, benchmark pricing, and generate spend analyses and statistical summaries.

Discover what's missing in your hospital's reimbursement for drugs

  • Gain visibility into hidden pharmaceutical coding errors and process gaps.
  • Discover errors in volume reconciliation that lead to compliance risk.
  • Identify where drugs purchased do not equal drugs billed.
  • Uncover inaccurate NDCs.
  • Identify exceptions that require correction.

Convert formulary and chargemaster discrepancies into new net revenue

  • Align prices for medications between hospitals and clinics.
  • Correct missing and incorrect multiplier issues that lead to improved operational processes.
  • Prioritize actions based on revenue value and potential risk.
  • Manage costs, internal pricing policies, and improved margins.
  • Quickly identify and respond to coding and regulatory changes.

Optimize for bundled and value-based reimbursement models 

  • Determine current pricing policy and margin impacts to optimize transition from fee for service to value-based reimbursement.
  • Achieve optimal reimbursement.
  • Cost to charge analytics ensures hospitals are billing appropriately.
  • Provides actionable analytics for improved financial decision making and metrics for population health.
  • Benchmark and monitor key performance indicators.

Pharmacy ChargeLink Implementation

Craneware Professional Services provides an implementation service that delivers a quick return on investment and ongoing benefits from using the software with expert consultation, best practices and effective business process design. The engagement includes a review and analysis of the previous 12 months' pharmacy purchase history and of the chargemaster's pharmacy data, onsite training, strategic reporting, and more.

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