A framework for graduate and postgraduate specialty pharmacy training

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose There is a growing need for specialty pharmacy leaders within integrated delivery networks (IDNs). Traditional training for students and residents has not met the demand for pharmacy leaders in this space. This article describes the partnership between UW Health (UWH) and the University of Wisconsin School of Pharmacy (UWSOP) in developing a specialty pharmacy elective course at UWSOP and in creating a postgraduate residency training program at UWH. Future directions for the partnership are discussed. Summary Members of the leaderships of UWH and UWSOP met to discuss expanding coursework related to specialty pharmacy business fundamentals at UWSOP. This meeting led to the development of a 2-credit elective course beginning in spring 2017. The course focused on marketplace economics, channel strategies, and specialty pharmacy practice development. Additionally, UWH identified the need to provide postgraduate training to meet the increasing demand across IDNs for specialty pharmacy leaders. The residency program was initiated in 2013 and received accreditation in 2016. The residency provides experience in specialty pharmacy leadership, managed care, finance, the revenue cycle, accreditation, and the supply chain. Future partnership opportunities include creation of a longitudinal student pharmacist track and joint project coordination between UWSOP students and UWH residents. Conclusion This partnership has provided a pathway for students to gain expertise in specialty pharmacy business fundamentals as well as postgraduate training opportunities for future specialty pharmacy leaders. IDN and school of pharmacy partnerships can expand educational opportunities for future specialty pharmacy leaders and help fulfill the market gap in specialty pharmacy leaders.

A proactive medical necessity review program reduces revenue loss associated with outpatient medical benefit drugs

Purpose A common denial trend that occurs with “outpatient medical benefit drugs” (ie, medications covered by a medical benefit plan and administered in an outpatient visit) is payers not requiring or permitting prior authorization (PA) proactively, yet denying the drug after administration for medical necessity. In this situation, a preemptive strategy of complying with payer-mandated requirements is critical for revenue protection. To address this need, our institution incorporated a medical necessity review into its existing closed-loop, pharmacy-managed precertification and denials management program. Summary Referrals for targeted payers and high-cost medical benefit drugs not eligible for PA and deemed high risk for denial were incorporated into the review. Payer medical policies were evaluated and clinical documentation assessed to confirm alignment. This descriptive report outlines the medical necessity workflow as a component of the larger precertification process, details the decision-making process when performing the review, and delineates the roles and responsibilities for involved team members. A total of 526 drug orders were evaluated from September 2018 to August 2019, with 146 interventions completed. Of the 761 individual claims affected by proactive medical necessity review, 99.2% resulted in payment and less than 1% resulted in revenue loss, safeguarding more than $5.3 million in annual institutional drug reimbursement. At the time of analysis, there were only 3 cases of revenue loss. Conclusion Our institution’s pharmacy-managed medical necessity review program for high-cost outpatient drugs safeguards reimbursement for therapies not eligible for payer PA. It is a revenue cycle best practice that can be replicated at other institutions.

Modelling of growth factors of coffee processing companies

In this paper, the growth factors of coffee processing companies in the Republic of Serbia were analyzed by panel data technique. The growth was measured by changes in sales, while as explanatory variables were defined the following: export, size, capital turnover, revenue cycle, current ratio (liquidity ratio), debt ratio and return on assets. The empirical examination was conducted on the basis of 160 observations of financial statements of companies in coffee market. The results show that coffee processing companies in the Republic of Serbia have an average positive growth rate (1.08) during period 2015-2018. Growth of coffee processing companies is significant negatively related to size, revenue cycle and current ratio. On the other side, profitability measured as return on assets has positive significant impact on firm growth. The results show the performances of coffee processing companies during period 2015-2018 and the profile of growth factors as a prerequisite for company's development. This information can be useful for the large number of internal and external users of financial statements in the process of decision making.

EVALUASI PENGENDALIAN PENJUALAN PRODUK PLASTIK UNTUK MENGURANGI KERUGIAN

Internal control review towards the revenue cycle is required to evaluate the effectiveness and efficiency of the existing management in order to support the achievement of company goals, and provide recommendations to allow corrective actions. These should be taken in order to review the role of internal control in increasing sale performance. This research used descriptive study method which could help to think systematically about various variables on a particular situation, to provide ideas for further research and to make simple decisions from the research that was done. Data collection techniques conducted were literature study and field study at Bandung Plastic company. Based on the result of internal control analysis, it was discovered that internal control set by the company will help company to handle loss of bad debt expenses, avoid fictitious sales, reduce improper sales target, reduce re-delivery cost, reduce erroneous task, and reduce environmental pollution.

The effect of COVID-19 on revenue cycle staff.

42 Background: The COVID-19 pandemic caused a public health emergency declaration in March 2020. A safer at home order was issued by the Tennessee governor on March 12 urging non-essential employees to stay at home. The decision was made to offer telecommuting to employees at Tennessee Oncology (TO) who could effectively work from home. 90% of the revenue cycle staff (RCS) began working remotely within a week of the decision. Methods: TO had been conducting a telecommuting pilot involving 20 RCS. This pilot was expanded within a week to accommodate 130 RCS including billing, credentialing, collections, financial counseling, analysts, authorization and benefit specialists. Employees signed telecommuting agreements and provided equipment based on IT recommendations. IT installed software which allowed secure connection through a Citrix gateway. Surveys were later conducted to measure work-from-home satisfaction. Less than 10 RCS remained onsite to perform essential duties. Results: Compared to the prior year there was an 80% reduction in turnover and an 82% reduction in unscheduled absences for telecommuting employees vs in-office employees. 92% reported an improved work/life balance. Productivity metrics by team are displayed below: Key financial metrics including payer turnaround, days in AR and patient payments improved over prior months. Payer turnaround dropped by 3 days and days in AR decreased by 3.9 compared to February. Patient payments were up 14% compared to the prior year. Conclusions: COVID-19 has been a challenging time in healthcare but it has taught us some valuable lessons. Telecommuting could be the wave of the future showing positive financial return in the form of employee retention, reduction of non-productive time (including unplanned absences) and increased employee satisfaction. Data shows these factors lead to higher producing team members who yield superior results. [Table: see text]

GADGET: AN ACCOUNTING DATA GENERATOR

With the proliferation of data analytics in the field of accounting, educators are in need of resources to enhance their curricula with analytics projects. This paper provides educators with a robust tool that generates large, unique revenue-cycle transaction data with certain realistic properties. The datasets can be used by educators to teach accounting-based data analytic procedures in accounting information systems, auditing, fraud, and data analytics classes. Additionally, multiple potential implementation opportunities for the datasets are proposed and a comprehensive example case is provided.

Identification of Master Patient Index Record Challenges from Healthcare Professionals’ Perspectives

Background A Master Patient Index (MPI) system is essentially a database that is built into an Electronic Health Record (EHR) system to maintain a unique identifier for each patient seen at the organizational or enterprise level. The current study is to identify the gaps between the revenue cycle and patient information functionalities used in Electronic Health Records (EHRs) in collecting and reporting patient information. Additional focus was on perceptions of healthcare professionals who are familiar with MPI systems on the impact of these gaps of ensuring maximum reimbursements and adequacy of services provided. The study also sought to glean their perceptions vis-a-vis key challenges in the EHRs that affect organizational workflow. Methods A semi-structured questionnaire was used to collect information from healthcare professionals responsible for the MPI. The population studied is healthcare organizations using EPIC as the Electronic Health Records (EHRs). Results This study confirmed systems gaps between EPIC and other downstream systems used by the healthcare organizations to process patient information, as well as the extent of patient matching challenges that healthcare professionals have encountered in the MPI. These challenges include varying methods of matching patient data; lack of data standardization; absence of policies and procedures; frequently changing demographic data; multiple required data points needed for record matching; and default and null values in key-identifying fields. Conclusions The study offered evidence found in the literature that implies that duplicate records continue to plague healthcare organizations. Widespread technological interoperability insufficiency among healthcare facilities points to future challenges for federal policy makers as they seek to promote interoperability programs to demonstrate meaningful use of certified electronic health record technology (CEHRT). Key messages The study confirmed that despite a low level of duplication in the MPI, the organizations have lost revenue during the last 6 months. Duplicate records in the EHR systems has led to downstream problems in the revenue cycle, including denials and insurance takebacks that impact hospital revenue cycle efficiency.