The reports are broken down into two groups
Facility Reports: These reports are utilized internally by facility staff to reduce pharmacy cost. These reports create a strong awareness, empowering the staff to assist in reducing unnecessary pharmacy related charges.
Pharmacy Reports: These reports identify billing discrepancies and areas in which the facility may have been billed incorrectly by the pharmacy. They are sent to the pharmacy by Integra Scripts as a request for credit .
High Costing Residents
This report identifies high costing residents and their associated drug charges, providing facility staff to gain a better grasp on pre admission screening, in accordance with pharmacy impacting reimbursement.
High Cost Managed Care
This alerts the facility to patients that are on a all inclusive rate but their drugs exceed the reimbursement, so that they can get higher rates or carve outs
This list is generated by our formulary which is has the most up to date medications and drug equivalents • Brands vs. Generics vs. OTC • Equivalent Dosages • Therapeutic Equivalents
Refill Too Soon
List of drugs that were refilled sooner than necessary
Lists all drugs which have not been used that can be returned
Prior Months Charges
Reports for charges from previous months inflating the current monthly invoice.
Lists medications that are being ordered by the facility that can be purchased from a third party supplier
Lists all office supplies on invoice
Drugs that would have been covered if a prior authorization would have been obtained
Identifies drug orders sent after the resident has been discharged from the facility based on census data
Reports residents being billed for pharmacy charges that are not listed on the facilities census data
Reports for residents that are eligible for higher rates of reimbursement based on diagnosis or managed care contract thresholds or stipulations
When processing the audit there are often miscellaneous charges which corporate management are surprised to hear about
Payer Source Discrepancies
Verifies the correct payer source and reports for discrepancies.
Verifies that drug pricing is per contract with the pharmacy and reports for discrepancies
Verifies that outliers were billed correctly and reports for discrepancies
Calculates accurate rates • Calculates correct number of days • And reports for discrepancies.
Reports non-exclusions the facility was charged for that where included in a per diem contract
Reports for drugs billed to facility covered by hospice.
When the responsible payer changes during a patient’s stay, enforce that every day is billed to the appropriate payer, and reports for discrepancies
Do Not Send
Reports for items noted to pharmacy as Do Not Send. For example, based on real-time notifications sent by facility or OTC stocked items.
Reports for duplicate claims • Duplicate orders sent • Overlapping days
Reports for miscellaneous, unauthorized charges.