Cost Containment Services
Price Verification (PVRx)
Recovers hidden costs by identifying overcharges and filing claims for recovery. Unlike do-it-yourself software, we perform fully autonomous historical and ongoing monthly reviews. We also reverify wholesaler denials and follow up until the credits are issued to your account. We review GPO, 340B, and WAC accounts and can even incorporate your individual agreements.
A monthly, just-in-time service providing optimized pharmacy purchase recommendations based on each facility’s utilization patterns, multiple contract options, and unique costs. With our human quality assurance team and pharmacy operational expertise, our service will provide the most feasible optimized savings opportunities possible while minimizing the pharmacy buyer’s time commitment to do so.
Margin Estimator (MERx)
Expense is important, but in a hospital outpatient setting, margin is more important. Margin Estimator provides a quarterly interactive dashboard service with the up-to-date calculations necessary to make an informed decision about the therapeutic alternative with the best margin between cost and reimbursement and how much a conversion to that alternative would mean to your facility or IDN.
TruDat (340B) Auditing Services
Contract Pharmacy Auditing
Designed to meet the requirements of Health Resources and Services Administration's (HRSA) Program Integrity Initiative, we retrospectively review 340B dispense records in covered entity retail operations and contract pharmacy relationships. We compare 340B dispensing to wholesaler purchase history and inventory/accumulator records, identifying over and under replenishment and an estimated financial position. Our 100% review reports provide a complete profile of both the financial and regulatory status in any 340B environment.
Mixed Use Pharmacy
Also designed to meet the requirements of HRSA’s Program Integrity Initiative, this is a retrospective review of internal dispense records compared to wholesaler purchase history and inventory/accumulator records. This service uses a sampling approach to identify issues in the data or systems used in a hospital’s mixed use environment.
Pharmacy Benefit Management
Compares dispensed medications against the Pharmacy Benefit Manager Auditing (PBM) contract to confirm accuracy of the charges. We can also compare against the client’s formulary or provider list to ensure correct processing.
Data Accuracy Services
Superior to static or outdated data, automated monitoring reports provide alignment of up-to-date NDCs in pharmacy formulary and facility billing systems based on recent purchases. Ensuring that billed NDCs are based on documented purchases improves billing compliance, price accuracy and reimbursement. 360Rx also aligns the facility charge master and the correct Healthcare Common Procedure Coding System (HCPCS) coding.
CDM Management (CDMRx)
Support and analytics for Customer Data Management (CDM) include:
Thorough system alignment, price consistency and coding compliance review
Price analytics and rate table modeling to determine revenue performance
System crosswalks to identify similarities and differences in data that can lead to better planning
Custom Data Analytics
In addition to our standard value service offerings, we work with our clients to develop customized data analytics solutions that meet unique and specific needs.
Our experience in health care informatics, supply chain operations and database development allows us to flexibly and rapidly develop complex and custom analytics solutions to meet emerging client requirements.