Why Close Collaboration Between Pharmacy and Revenue Cycle Management Teams is More Important for Your Health System Than Ever

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By: McKesson Health Systems Editorial Team

As drug spend remains a growing cost for health systems each year and reimbursement and regulatory landscapes continue to change, healthcare as a whole is rapidly evolving – from how it’s delivered, to who’s involved, to the way it ultimately gets paid for. Along with that, the health system pharmacy’s role has expanded in recent years from a traditional medication dispensary to a meaningful contributor to the financial health of the system. With this in mind, hospital leadership should consider the benefits of encouraging an even closer collaboration between their pharmacy and revenue cycle management (RCM) teams.

A team approach

In health systems, the RCM team bears responsibility for almost anything revenue-related – from developing high-level financial strategies for the entire health system to overseeing the more granular processes like billing and claims processing – to ensure the health system is appropriately reimbursed for the care they provide and that their financial processes remain compliant and efficient.

“Downstairs,” the health system pharmacy supports patient care in a number of ways, including its primary function of dispensing medications. While filling prescriptions is still a necessary and important part of the health system pharmacy’s responsibility, pharmacy leaders today are also deeply engaged in many business aspects of healthcare, including cost containment and revenue growth, with a focus on transforming what has historically been a cost center into a revenue driver. Clinically, health system pharmacists are increasingly involved in the broader healthcare team, contributing to medication-related decisions, controlling the hospital formulary, supplementing treatment plans with clinical and operational expertise, and helping to ensure patients receive the medications they need, when, where, and how they need them – with the added consideration of cost to both the patient and the provider.

Beyond cost containment alone, there is now a greater opportunity than ever for the pharmacy to influence positive patient outcomes and support the system’s financial stability by increasing revenue capture, reducing or preventing revenue loss, ensuring billing compliance, improving medical reimbursement, and more – all through closer and more consistent engagement with the hospital’s RCM team.

A unique perspective

With their boots-on-the-ground vantage point and in-depth clinical and operational knowledge, adding pharmacy teams to RCM conversations can yield significant dividends. Working together, pharmacy leaders and the RCM team can amplify their individual efforts in cutting or containing expenses and maximizing reimbursement, with the pharmacy team advising in areas like the hospital’s drug formulary, drug acquisition costs, and others. At the same time, pharmacy leaders can help minimize the risk of billing code errors or omissions that may result in underpayments or claim denials, which can negatively impact revenue capture. From a compliance perspective, bringing pharmacy and RCM teams together allows for a more complete understanding and successful application of payer-specific guidelines, such as formulary restrictions, prior authorization requirements, or step therapy protocols to help medication reimbursements comply with payer requirements and avoid costly penalties.

The keys to success

With the increased revenue capture and maximized reimbursement that can potentially be achieved with a closer partnership between pharmacy and RMC teams, health systems can improve both their financial stability and the ability to provide quality patient care. Among the keys to a successful collaboration between your health system’s pharmacy and RCM teams are:

• Integrating data
• Providing education
• Improving processes
• Monitoring performance
• Implementing collaboration initiatives
• Promoting continuous improvement

At McKesson Health Systems, our value-added services can help you improve collaboration and business results across your health systems through all of these strategies and more. According to the Coordinator of Pharmacy Revenue and Business Operations at Yale New Haven Health, an MHS customer, “[McKesson’s] Revenue Recovery has improved compliance, accurate billing, and collaboration with other departments. Adding these safeguards enables us to be a lot more productive and efficient.” In another case, our value-added services and solutions helped a health system customer identify 30 underpayment accounts during each two-month reporting period in just one year.

To learn more about how we can help you achieve more for your business of pharmacy and the patients you care for, contact McKesson to speak with one of our professional advisory experts today.