Tip: Designate staff member to monitor drug compendia
APCs Weekly Monitor, May 14, 2010
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Drug compendia are designed to educate their users with respect to both clinical and financial information, but they don’t always all say the same thing. Because coverage determinations are complex, an individual at each facility should be responsible for regularly monitoring changes in compendia and tracking payer policies.
HIM directors at large facilities should designate a full-time staff member to monitor the intersection of compendia with respect to payment policy and coverage. Case management staff members at smaller facilities could assume responsibility for monitoring compendia.
Don’t forget to keep an eye on claims denials as well. This ensures that you’ll know what actually occurred at the back end regardless of what you had anticipated at the front end.
This tip is adapted from “Complex compendia rules complicate reimbursement” in the May issue of Briefings on APCs.
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