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University of North Carolina Hospitals

 

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Lineberger Comprehensive Cancer Center
Chapel Hill, North Carolina

Reducing Revenue Loss and Patient Financial Toxicity with Pharmacy Pre-Certification and Denials Management

Suzanne Francart, PharmD, BCPS, Assistant Director of Pharmacy at the University of North Carolina Hospitals

Revenue protection at UNC Hospitals, including Lineberger Comprehensive Cancer Center, is dependent on optimized drug reimbursement at its infusion centers. As pre-certification requirements expanded, the UNC Department of Pharmacy developed a closed-loop, pharmacy-managed, pre-certification and denials management program, serving as an innovative model that provides significant added institutional and patient value. This approach has helped to both mitigate institutional risk of revenue loss due to denied claims and alleviate patient distress due to the financial toxicity associated with treatment.

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Proactive Precertification Pays Off

innovatorawards-2019-sealSingular-80x80At Lineberger Comprehensive Cancer Center at the University of North Carolina (UNC) Hospitals, the drug revenue cycle was spread out over several different departments, with no one department having complete ownership of it. “With different groups tackling different parts of the revenue cycle in siloes, they didn’t know how they fit into the larger process,” says Dr. Francart, assistant director of UNC’s Medication Assistance Program and Pharmacy Revenue Integrity Team in the Department of Pharmacy at UNC Hospitals.
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Christian G. Downs, JD, MHA, ACCC Executive Director; Ali McBride PharmD, MS, BCOP, ACCC President 2019-2020; Suzanne Francart, PharmD, BCPS, University of North Carolina Hospitals; Randall A. Oyer, MD, ACCC President-Elect 2019-2020

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Suzanne Francart, PharmD, BCPS, Assistant Director of Pharmacy at the University of North Carolina Hospitals, shares the processes that her program implemented to improve operations and patient care

 

Featured in Oncology Issues

Reducing-Revenue-Loss-and-Patient-Financial-Toxicity-with-a-Pharmacy-Managed-Pre-Certification-and-Denials-Management-Program-223x300Reducing Revenue Loss and Patient Financial Toxicity with a Pharmacy-Managed Pre-Certification and Denials Management Program

In an era of soaring drug prices, payers have developed complex strategies to manage costs and ensure clinically appropriate prescribing in the outpatient environment.1-3 Some of the most frequently used strategies include requiring prior authori­zation before treatment and implementing medical coverage policies with clinical criteria outlining coverage parameters. Because providers are unable to bill for a drug prior to dispensing it, institutions are often left balancing the need to start expensive treatments with uncertainty about reimbursement. A proactive approach to understanding and complying with payer-mandated requirements is vital to ensuring that millions of dollars in treat­ments are not lost to payer denials.
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Podcast

Oncology pharmacy has undergone a rapid transformation in recent years. Learn more about the role that oncology pharmacists play in cancer care and how that role is changing in the face of new therapies and the advent of value-based health. Discover how the University of North Carolina Hospital’s Department of Pharmacy developed a closed-loop, pharmacy-managed, pre-certification and denials management program to avoid passing surprise bills to patients and ensure financial stability for the cancer program.

Guests:
Ali McBride, PharmD, MS, BCOP, Clinical Coordinator of Hematology/Oncology, University of Arizona Cancer Center, Department of Pharmacy; 2019-2020 ACCC President
Suzanne Francart, PharmD, BCPS, Assistant Director of Pharmacy, The University of North Carolina Hospitals