Maintaining a hospital EMR formulary is incredibly demanding and complex. Managing the dynamics of new drugs, different manufacturers, solutions, units of measure, and more; all under the watchful eye of CMS, Joint Commission, the FDA, and other regulatory bodies, is a daunting task. Beyond the all-important safety component of formulary management is the supply chain and revenue cycle. Every EMR has tools dedicated to managing aspects of the formulary, but rarely do they fully meet the rigors of managing thousands of medications, each with dozens of manually maintained fields. Prioritizing the following points and identifying current deficiencies in visibility or processes can lead to significant strides in Pharmacy performance throughout the organization.
CMS Guidelines Compliance
- Stay abreast of CMS guidelines related to formulary management, including Medicare Part D regulations and requirements.
- Ensure that the formulary is compliant with CMS standards for drug coverage, prior authorization, step therapy, and medication therapy management (MTM) programs.
Coding System Maintenance
- Quantity Conversion Factor (QCF), HCPCS codes, and NDCs are constantly being updated. Currently, many systems require manual maintenance of these crucial fields. Human error can lead to improper billing, supply chain failures, and denied claims.
- Implement coding protocols to streamline documentation, billing, and reporting processes while adhering to industry standards.
- Use software that automatically crossmatches the formulary database to a controlled medical terminology library (e.g. Multum).
FDA Regulations and Safety Alerts
- Monitor FDA approvals, safety alerts, recalls, and labeling changes to keep the formulary up-to-date with the latest medication information.
- Incorporate FDA regulatory updates into formulary management processes to ensure patient safety and compliance with regulatory standards.
Integration of Drug Databases
- Integrate drug databases like Multum and PharmNet into the EMR system to access comprehensive medication information, including dosing guidelines, indications, contraindications, and drug interactions.
- Regularly update drug databases to maintain accuracy and relevance of medication data within the formulary.
Reimbursement Optimization
- Optimize reimbursement strategies by aligning formulary decisions with reimbursement policies, formulary tiers, and patient cost-sharing requirements.
- Monitor formulary performance and utilization patterns to identify opportunities for reimbursement optimization and cost containment.
Support Software Solutions
- Leverage advanced EMR software with robust formulary management features to streamline formulary maintenance processes.
- Utilize support software for formulary decision support, drug utilization review, adverse event monitoring, and clinical decision support.
- Implement software tools for formulary analytics, reporting, and predictive modeling to drive evidence-based formulary decisions and improve patient outcomes.
By leveraging clinical pharmaceutical expertise and utilizing support software solutions effectively, you can ensure the integration, compliance, and optimization of the EMR formulary to support high-quality patient care, regulatory compliance, and financial sustainability in healthcare settings.
Softek offers Oracle Cerner organizations a real-time view of their formulary to see what is needed for correct charging. Our tools identify formulary issues to get the proper reimbursement and correct the price schedule for formulary items. We also alert you when a drug is becoming obsolete.
With our insight and innovative solutions, you can easily identify reimbursement and denial-related issues within the Pharmacy Formulary, including missing HCPCS, incorrect QCFs and obsolete NDCs in use.
What does Softek® do?
Softek’s mission is to help hospital systems maximize their investment in Oracle Cerner Millennium®. We do this by providing innovative software solutions and consulting services that can achieve more together than either can alone.
At Softek, our team of innovators and software developers brings expertise beyond the ordinary to every client. Our experts are involved with Oracle Cerner Millennium® hospitals throughout the country, consulting clients so they can optimize system performance and revenue integrity.
Softek delivers a full suite of consulting services and software solutions to assess and optimize EMR system performance, including revenue cycle integrity and patient accounting.
Softek was awarded 2021 Best in KLAS for Revenue Cycle Optimization.
Let’s talk about how you can get the most out of your Oracle Cerner Millennium® system.
