High Cost Drug Program
Each year, healthcare payers spend increasingly more on claims for high cost drugs. While these drugs can be lifesaving for the patients who use them, their rising costs have dramatically impacted healthcare profitability.
Some providers are deliberately taking advantage of the healthcare industry’s confusion surrounding the proper billing and payment for high cost drugs. Coupled with this, spending on high cost drugs is expected to more than double from its present level of $40 billion annually, to over $90 billion by 2009.
Lowering Your High Cost Drug Payments
WayMark Associates’ High Cost Drug Program assists healthcare payers in navigating through the ever-changing landscape of high cost drugs. By combining specialty audit with consulting services, this Program not only helps clients identify and recover past overpayments, it also provides them ways to minimize inappropriate payments in the future.
Key services include:
• Identifying “one-off” overpayments that can be promptly pursued with little or no review of supporting documentation or discussions with providers.
• Identifying and addressing situations that require more extensive auditing through an “on-site” or “desk” review of a provider’s supporting documentation. These situations may be identified based on factors such as total claims volume, unusual billing patterns and the uses and types of drugs being dispensed.
• Reviewing various components of your organization’s provider contracts, authorization processes and payment policies and procedures that may be leading to overpayments.
• Applying a proprietary “360 degree approach” to auditing and consulting to ensure a thorough and comprehensive review designed to maximize overpayment identification and financial recoveries, as well as ongoing advice designed to fix existing problems and prevent future overpayments.
WayMark Associates’ High Cost Drug Program will help your organization
significantly lower its expenditures on high cost drugs while improving
profitability. In a segment of the industry where payer costs are skyrocketing,
this should bring welcome news.
