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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

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At 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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[PODCAST] Episode 7: The Evolution of Oncology Pharmacy

Oct 29, 2019

Find the CANCER BUZZ podcast on Apple Podcasts, Spotify, or wherever you get your podcasts!

Oncology pharmacy has undergone a rapid transformation in recent years. On this episode of CANCER BUZZ, 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

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