How Your Healthcare Revenue Cycle Is Affected When You Add a Specialty Pharmacy

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Working with so many healthcare organizations on facets of revenue cycle management like billing and practice management over the years, we know industry trends can have huge impacts on our clients. From regulatory changes to new technology advancements, changes in the industry affect how our clients do business.

Acquiring or launching a specialty pharmacy practice is one trend we’ve been keeping our eyes on recently. It has grown in popularity due to soaring drug prices. Has your practice thought about how acquiring or building a pharmacy practice might impact your revenue cycle in the short and long term?

Benefits of Acquiring or Launching a Specialty Pharmacy

The trend of pharmacy growth didn’t come about in a vacuum — like most healthcare trends, it grew to fill a gap.

In 2014, the United States spent $124.1 billion on specialty drugs, up from $98.1 billion in 2013. Despite an average growth for pharmaceuticals of 20 percent a year, hospitals fill their own prescriptions less than 20 percent of the time, and clinics and outpatient services are often comparable. This highlights a sizeable gap where practices who might need specialty drugs for patients or procedures are putting a significant portion of their revenue at the mercy of a third party that is not bound by payer contracts or rates.

Four Ways to Measure an Electronic Health Record Transition’s Effect on Revenue Cycle

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Gone are the days when the good ship Healthcare Practice floated on a sea of paper. Today, most of us work with electronic health record (EHR) systems to do everything from access patient information to streamline lab testing.

As of 2012, 72 percent of physician offices used EHR systems. That’s up from less than 50 percent in 2009, when the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed, providing incentives from Medicare and Medicaid to organizations that made a commitment to “meaningful use” of technology and adopting EHR systems. Since the 2012 data, we’ve certainly noticed even more healthcare entities adopting EHR systems and upgrading from older ones to new systems.

We worked with a Nevada clinic to help it transition from paper records to an EHR, and another practice as it went from one cloud-based EHR system to another that better suited its needs. Since these were already clients of ours, we were in a position to warn them that EHR migrations often result in unplanned revenue cycle disruptions. Outbound claims can stagnate as staff undergo training and learn the new system. Everyone’s emphasis on revenue optimization can falter as multiple departments prepare for migrating from paper to EHR, or from an existing EHR to a new one.

Mind the Gap: How the ICD-10 Transition May Have Exacerbated Your Revenue Cycle Difficulties

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Over the past several months, we’ve come to some realizations we hadn’t previously about the recent big change to ICD-10: Many healthcare organizations who used the grace period leading up to ICD-10’s official arrival to prepare were blindsided by the little ways ICD-10 immediately impacted what they thought were small areas of their revenue cycle.

By any measurement, and in any context, going from 13,000 of something to 68,000 of something is a big jump. When we’re talking about codes used to drive the payments and reimbursements of one of our country’s most crucial and complex industries — healthcare — it’s easy to see why the ICD-10 transition is considered one of the most important changes in the field in a generation. For the most part, it looks like the big-picture transition has gone very smoothly for almost all healthcare entities and payers — everyone is mostly using the right codes and not seeing a drastic rise in rejected claims or other issues.

Streamline Your Revenue LifeCycle Through HIPAA’s Administrative Simplification Regulations

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When we meet with clients, we often discuss several different audit streams that help us evaluate their revenue cycle and ways to improve it. One area that we’ve found to be of particular frustration for many practices is HIPAA’s Administrative Simplification requirements. Compliance with these requirements is key to an organization’s revenue cycle, and important […]