Monthly Reviews

Monthly Pharmacy Reviews are a comprehensive analysis on the monthly pharmacy bill prepared by Integra on a monthly basis.

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 .

Facility Reports

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

Rx Recommendations

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

Returnables

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.

OTC

Lists medications that are being ordered by the facility that can be purchased from a third party supplier

Office Supplies

Lists all office supplies on invoice

Prior Auth

Drugs that would have been covered if a prior authorization would have been obtained

Patient Discharged

Identifies drug orders sent after the resident has been discharged from the facility based on census data

Unidentified Residents

Reports residents being billed for pharmacy charges that are not listed on the facilities census data

Special Rates

Reports for residents that are eligible for higher rates of reimbursement based on diagnosis or managed care contract thresholds or stipulations

Anomalous Charges

When processing the audit there are often miscellaneous charges which corporate management are surprised to hear about

Pharmacy Reports

Payer Source Discrepancies

Verifies the correct payer source and reports for discrepancies.

Contract Pricing

Verifies that drug pricing is per contract with the pharmacy and reports for discrepancies

Outliers

Verifies that outliers were billed correctly and reports for discrepancies

Per Diem

Calculates accurate rates • Calculates correct number of days • And reports for discrepancies.

Non Exclusions

Reports non-exclusions the facility was charged for that where included in a per diem contract

Hospice

Reports for drugs billed to facility covered by hospice.

Split Billing

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.

Duplicates

Reports for duplicate claims • Duplicate orders sent • Overlapping days

Anomalous Charges

Reports for miscellaneous, unauthorized charges.