A Drug Trend report published in 2009 had predicted continued price increase among traditional branded and biotech drugs that lack generic competition. Now, further, CMS has reduced its Average Sales price (ASP) margin from 6 percent to 4 percent for non-pass-thorough. This has affected pharmacy reimbursement. However, there are certain other aspects of Pharmacy Billing that can affect reimbursement and thereby the Revenue Cycle Management (RCM) process if not well implemented.
1. Data Workflow:
Recognizing how the revenue cycle works in pharmacy is very essential. Procurement to Inventory, billing and reimbursement involves purchase of medications, their storage, and method of dispensing, how they are administered, way they are coded & billed, and finally reimbursed. If the drug is covered as a pharmacy benefit, or the payer needs that to be obtained via a specialty pharmacy as identified through patient-specific benefit verification, then here both the provider and the pharmacy are part of the reimbursement process. The physician writes a prescription and orders the drug. This is followed by the pharmacy that fills the order and issues the drug to the physician, CMHC, or hospital outpatient department. Here the pharmacy bills the insurance company for the drug. If any information is entered incorrectly into the pharmacy system in the initial phase of the cycle, errors can prove to be costly, impacting aspects of clinical and revenue cycle.
2. Procurement:
During this phase information is converted from purchased quantities and pricing to storage units of measure (UOM) and inventory costs. Manually entering the data is followed in most cases. UOM conversions, when data is uploaded from the wholesale distributor to the pharmacy system, are also checked and verified manually. Here too mistakes can lead to breakdown in the revenue cycle management (RCM) process.
3. The Charge master:
Critical & substantial revenue leakage can occur when separately reimbursable medications are either missing from or miscoded in the charge master. Conversion of pharmaceutical quantities is a must from purchased amounts to patient-administered amounts, and only then made billable. There is often a difference between dosage amounts required for patient use as from that purchased. Besides inventory, the clinician and pharmacist should convert dosage, strength, and delivery mechanism for each drug. Drug data must be correctly converted from the quantities residing in clinical systems into the payer-billable quantities appropriate for the financial system or charge master. The UOMs must be reconciled to avoid any under- or over-payments. More than often, missing or incorrect data in the charge master can result in negative financial consequences – denied claims, partial reimbursement, and compliance risks.
4. Linkages between Purchases & Billing:
Most hospitals have separate processes to order drugs, administer them, and process reimbursement. Without linkage between pharmacy expenditures for medications (i.e., spend data) and the charge master, ensuring proper charge capture and optimal reimbursement is a challenge. Besides hospitals should have automated tools to identify charge capture errors precisely, so as to pinpoint when and where their occurrence to decreasing revenue loss.
Lymph capillaries are thin walled capillaries interwoven with blood capillaries and found throughout the body except nervous system, bone marrow, and tissues that do not contain vascular tissue like epidermis.
The role of lymphatic capillaries is to collect the extra fluid which is secreted by the tissues in the intercellular spaces. This fluid is called lymph and is clear and transparent and contains WBCs and plasma.
Lymph is different from blood because it do not contain RBCs and platelets. Lymphatic vessels are important part of body immunity because it contains many WBCs in their lymph helpful in fighting diseases.
Jack is the manager, he does have the authority to correct Samantha but it is also his responsibility to make Samantha comfortable. He could have explained the situation to her calmly and make her understand the problem.
He failed to some extent but he could rectify the mistake by apologizing and providing Samantha a clear explanation about how she can improve her performance. If Samantha does go to the PR and reports Jack, both of them leave the problem unsolved indicating lack of proper communication.
A manager should be able to interact well with their workers and make them see the benefits for the company and their personal interests and then invest their effort into better performance.
Alcohol travels through body from mouth, to stomach, into circulatory system, brain, kidneys, lungs and liver.
Alcohols when consumed gets passed through the mouth in the stomach. <u>As carbohydrates, alcohol are not digested as the molecule is very small and can easily pass through stomach lining, where the alcohol passes directly into bloodstream. Once it enters bloodstream, the alcohol is quickly distributed evenly throughout body.</u>
The conscious client was admitted to the emergency department with an overdose of the anxiolytic alprazolam (Xanax). The nurse implement first prepare to administer an emetic with activated charcoal.
Chemicals can be captured in the pores of activated charcoal. In order to treat some poisons that have been ingested, it is normally administered orally. For additional purposes, the evidence is scant. Peat, coal, wood, coconut shells, or petroleum can all be used to make charcoal. Charcoal is heated in the presence of a gas to create activated charcoal. The charcoal develops numerous interior pores as a result of this process. Activated charcoal may trap pollutants thanks to its pores. To treat poisoning, activated charcoal is frequently employed. Additionally, it is claimed to treat excessive cholesterol, hangovers, and upset stomach, but the majority of these applications lack solid scientific backing.
