Strategic Pricing Solutions

Strategic Pricing Solutions Hospital | Pharmacy | Physician

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Contents Hospital Zero-Base Pricing Compare our Features

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PHARMauditor 6 The Pharmacy Revenue Cycle Improvement Solution

Physician Pricing

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Hospital Zero-Base Pricing® In this era of intense public scrutiny, Panacea provides a proven cost and market-based strategy that delivers the pricing discipline the market demands while achieving your net revenue objectives.

Clearly the most defensible price is one that is based on actual cost. Over the decades with many hospitals being reimbursed or paid less than cost by federal and managed care payers, shortfalls were subsidized through selective price adjustments or cross-subsidization. After years of deploying such techniques, hospital administrators are found today in an era of intense public price scrutiny with chargemasters incredibly difficult to explain.

The Hospital Zero-Base Pricing® program establishes prices based on actual unit costs and ¤

provides comparisons to local peer’s prices. Where needed, we use sophisticated software and analysis to estimate unit costs. This saves the burden and expense of implementing a traditional cost account system. Before finalizing price models, some prices are adjusted to ensure that the cost-based prices don’t fall below contractual amounts and that others remain competitive. You also receive net revenue models for multiple pricing scenarios and a comprehensive audit trail for each line item. In short, you have exactly what you need to defend your pricing.

Key Benefits *H FMA 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.

Prices can be established based on a hybrid of unit cost, multiple market groups, fee schedules and other parameters to be rational and defensible Maintains your net revenue objectives Considers medicare and non-medicare, APC rates, and fee schedules Pricing is competitive and defensible Cost accounting system is not required Multiple pricing scenarios presented Provides audit trail for future reference

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Compare our Features Panacea’s Hospital ZeroBase Pricing®

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Multi-user capability.

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Report results to screen and to Excel.

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Web-based, secure HIPAA-compliant platform.

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no additional cost.

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Has received the coveted HFMA Peer Review designation.

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Sort report results on screen by selected column.

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Consulting team has experience with hundreds of hospitals

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Advanced Health System reporting functionality. Run one or more models simultaneously and view and print.

Modeling can incorporate multiple peer groups (e.g. market group for most departments and cardiology, oncology, etc. for specialty areas.)

Perform market-based, cost-based, or hybrid pricing models ¤

with gross and net revenue impact by department, payor, patient type, and CDM line item.

Subscription/license fee includes expert consulting support at

System allows for integration of different peer groups for different or specialty services.

System calculates net impact of payor caps.

System produces comprehensive set of reports identifying lost and recovered revenue related to “lessor of charge and fee schedule” clauses in managed care contracts.

System allows for overrides to general parameters at the department, HCPCS code, revenue code and service code levels.

System produces electronic IT upload file of new prices to reduce implementation errors related to data entry.

nationwide.

Company has both financial and clinical CDM coding expertise.

Option to perform claims level analysis to assess impact of current and new prices on stop loss reimbursement and lessor of charge and bundled rates claims.

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Panacea’s Hospital ZeroBase Pricing®

Some other vendors

Most or all other vendors

Web-based access to databases from over 5,000 hospitals and more than 600,000 medical office and free-standing facilities to access HCPCS level charges, room and board rated, and charge-to-cost mark-up factors to develop

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unlimited custom peer groups.

Integration with consumer analytics and ability to flag during modeling highly shoppable procedures during modeling.

Technical / customer support included at no additional cost.

System or consulting service fee includes use of system or service during budget season, during annual price implementation and to do interim look-back models to identify interim adjustments if needed.

System allows for customizable pricing parameters or constraints surrounding high charge, low charge or zero charge payor factors by line item and overall.

System allows for customizable peer group corridors, corridors around Medicare APC, fee schedules, and managed care and commercial fee schedules.

Additional discounted consulting support offered if needed during term of contract.

Optional use of Unit Cost Estimator system to expediently develop unit costs for entire or partial chargemaster in the absence of a cost accounting system.

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System can be used to easily develop budget year usage statics at the payor plan code, patient type, department, and CDM line item level. System can also be used for budget year

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gross and net revenue modeling related to price changes.

System produces extensive set of data exception reports, such as CDM items with volume and no charge and multiple uses of HCPCS code with different prices, etc.

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System allows health systems to develop a sophisticated model for their flagship hospital and then copy and run configuration utilizing the same data for other hospitals within

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the system.

Proprietary “peer group” net revenue optimization feature that increases net revenue within rational pricing parameters.

System allows for customizable outlier cut off criterion for use in refining peer group norms at HCPCS level (e.g., define min

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# hospitals and % variation from mean or median).

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PHARMauditor™ Ensure your pharmacy chargemaster is correct and compliant.

CHARMauditor.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-9-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

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The Pharmacy Revenue Improvement Solution With Panacea’s Pharmacy Revenue Improvement solution, not only will your formulary and chargemaster be accurate and up-to-date, but you will also have defensible, best-practice drug pricing that minimizes coding and billing risks.

A Complex System As a leader in the hospital pharmacy, you juggle the complexities of almost daily reimbursement rule changes and skyrocketing drug prices. Panacea’s expert team can help: Help to integrate pharmacy data Updating the formulary Auditing and generating reports on a regular basis Ensuring you have the power to hunt down lost revenue Finding gaps in pharmacy data as it moves through disparate billing systems or has been “standardized” through an EHR Converting dosed or dispensed drug amounts to billable units as easily as possible The pressure to balance these elements is constant. To help you stay on top of it all and initiate, support, or expand your pharmacy’s Revenue Integrity Program, Panacea can work with you on these common issues: Mapping of NDC, HCPCS, revenue codes, and billable units Validating documentation of drugs ordered, dispensed and administered, and billed Identifying the appropriate defensible pricing methodology for mark-up Ensuring more accuracy to decrease claim rejections due to errors

Save Time While Ensuring Accurate and Compliant Pharmacy Revenue Panacea combines industry experts with sophisticated analytic software to alleviate the pressures of limited resources and pharmacy revenue loss by bringing in the right experts using software they themselves helped create. Panacea has helped hundreds of pharmacies and can bring that experience to you.

1. A Panacea consultant will conduct a documentation review and comprehensive analysis to uncover any coding and billing risks. Our consultant will focus on your charge capture processes and pharmacy chargemaster using its PHARMauditor™, Panacea’s cloudbased software tool. This industry expert validates accurate charge capture, coding, claims processing, and receipt of accurate payment so that you do not miss charges or have incorrect billing units. Panacea will also evaluate reimbursement and denial patterns identified during the documentation review.

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2. Your Panacea expert will complete a formulary review to check for coding compliance and appropriate pricing. They will use PHARMauditor with its extensive database of current NDC numbers to accurately code map HCPCS, revenue, billable unit, AWP or WAC cost. This one-time pharmacy formulary cleanup ensures that codes and costs are current and correct.

The Complexity of Pharmacy Pricing As an example of how complex pharmacy pricing can be, consider BENLYSTA, an intravenous drug available in a 120mg per 5mL single-dose package and a 400mg 20mL single-dose.

Selecting the correct unit when billing is critical because price depends on the dose given and the cost of each vial.

For example, consider a 360mg dose given April 5, 2017. If the NDC for the 400mg/20mL package is used the cost is $1,992.02. However, only 18mL is used, creating waste of 2mL with a cost of about $200 for this single patient dose. Although perhaps counterintuitive, using 3 vials of the 120mg/5 mL would cost the same without the need to waste $200 worth of medication. Ensuring accurate reporting of waste and tracking reimbursement adds one more layer of complexity to pharmacy billing.

Panacea’s experience in the complexities of pharmacy pricing and our PHARMauditor tool facilitate a comprehensive review and assessment of coding compliance. With us, you will be able to assess and maintain an accurate pharmacy charge description master, formulary, and coding and billing compliance.

Getting Started Is Easy

KEY BENEFITS Uncover coding and billing risks Reveal new incremental revenue opportunities Update and maintain accuracy and data integrity Formulary Chargemaster or other charge data file

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 Hospital list

Decision support systems

Department list

Create rational and defensible

Usage data at the NDC level

best-practice drug pricing Reduce risk for RAC and OIG audits

Any special data specifications if you have dynamic information systems Access to select medical records for review of medication orders eMAR Nurse documentation of administration Detail itemized bill Remittance advice from payor(s)

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Physician Pricing Panacea’s Physician Pricing system is the outgrowth of its nationally acclaimed Hospital Zero-Base Pricing® technology and services and the demand resulting from its hospital clients’ ever-growing physician practice business.

With the integration and/or acquisition of physician practices, it is imperative that hospitals develop rational and defensible physician charges utilizing a consistent methodology across all specialties and practices that takes into account market data, payer fee schedules, estimated or actual costs and net revenue objectives.

Key Benefits Prices are established with consideration to RVU benchmarks and/or actual or estimated unit cost Pricing algorithm also considers current customized physician market data at CPT-4 level Ensures charges aren’t below allowable Medicare and non-Medicare fee schedule amounts Results in rational and defensible prices that you can explain and defend Achieves and maintains your net revenue objectives Multiple pricing scenarios presented Provides audit trail for future reference

For more information, call us at 866-926-5933 or register for a free on-demand demonstration at panaceainc.com.

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Minnesota

New Jersey

Panacea®

Panacea®

444 Cedar Street

595 Shrewsbury Ave

Suite 920

Suite 201

St. Paul, MN 55101

Shrewsbury, NJ 07702

Ask about Panacea’s HFMA peer-reviewed solutions – Hospital Zero-Based 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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