Dana RPh Director Pharmacy Rapid City Regional...
Transcript of Dana RPh Director Pharmacy Rapid City Regional...
![Page 1: Dana RPh Director Pharmacy Rapid City Regional Hospital340bwinterconference.org/assets/uploads/02_04_345pm_Darger_1.pdf · Who Is Regional Health • Rapid City Regional Hospital](https://reader034.fdocuments.in/reader034/viewer/2022052419/5a7890cd7f8b9ae91b8c2c83/html5/thumbnails/1.jpg)
Dana Darger, RPhDirector of Pharmacy
Rapid City Regional Hospital
![Page 2: Dana RPh Director Pharmacy Rapid City Regional Hospital340bwinterconference.org/assets/uploads/02_04_345pm_Darger_1.pdf · Who Is Regional Health • Rapid City Regional Hospital](https://reader034.fdocuments.in/reader034/viewer/2022052419/5a7890cd7f8b9ae91b8c2c83/html5/thumbnails/2.jpg)
Statement of Conflicts of Interest Dana Darger has no actual or potential conflict of interest in relation to this presentation
![Page 3: Dana RPh Director Pharmacy Rapid City Regional Hospital340bwinterconference.org/assets/uploads/02_04_345pm_Darger_1.pdf · Who Is Regional Health • Rapid City Regional Hospital](https://reader034.fdocuments.in/reader034/viewer/2022052419/5a7890cd7f8b9ae91b8c2c83/html5/thumbnails/3.jpg)
Today’s Agenda Composition of a Hospital 340B Compliance Team Why have a compliance program Hospital 340B Self‐audit
![Page 4: Dana RPh Director Pharmacy Rapid City Regional Hospital340bwinterconference.org/assets/uploads/02_04_345pm_Darger_1.pdf · Who Is Regional Health • Rapid City Regional Hospital](https://reader034.fdocuments.in/reader034/viewer/2022052419/5a7890cd7f8b9ae91b8c2c83/html5/thumbnails/4.jpg)
![Page 5: Dana RPh Director Pharmacy Rapid City Regional Hospital340bwinterconference.org/assets/uploads/02_04_345pm_Darger_1.pdf · Who Is Regional Health • Rapid City Regional Hospital](https://reader034.fdocuments.in/reader034/viewer/2022052419/5a7890cd7f8b9ae91b8c2c83/html5/thumbnails/5.jpg)
Who Is Regional Health• Rapid City Regional Hospital
‐417 Bed Disproportionate Share Hospital• Spearfish Regional Hospital
‐40 Bed Sole Community Hospital• Sturgis Regional Hospital
‐25 Bed Critical Access Hospital• Custer Regional Hospital
‐16 Bed Critical Access Hospital• Lead‐Deadwood Regional Hospital
‐18 Bed Critical Access Hospital
![Page 6: Dana RPh Director Pharmacy Rapid City Regional Hospital340bwinterconference.org/assets/uploads/02_04_345pm_Darger_1.pdf · Who Is Regional Health • Rapid City Regional Hospital](https://reader034.fdocuments.in/reader034/viewer/2022052419/5a7890cd7f8b9ae91b8c2c83/html5/thumbnails/6.jpg)
Why Is a Compliance Program Necessary HRSA
“340B Drug Pricing Program covered entities must ensure program integrity and maintain accurate records documenting compliance with all 340B Program requirements.”
“The 340B Program offers eligible safety net health care providers access to low‐cost medications, which allows them to expand the type and volume of care they provide to the most vulnerable patient populations. HRSA places the highest priority on the integrity of the 340B Program and continually works to strengthen the oversight of this program.”
![Page 7: Dana RPh Director Pharmacy Rapid City Regional Hospital340bwinterconference.org/assets/uploads/02_04_345pm_Darger_1.pdf · Who Is Regional Health • Rapid City Regional Hospital](https://reader034.fdocuments.in/reader034/viewer/2022052419/5a7890cd7f8b9ae91b8c2c83/html5/thumbnails/7.jpg)
340B Compliance Committee VP Compliance Legal Services 340B Specialist Assistant Director Outpatient Pharmacy Services Pharmacy Business Support Supervisor Pharmacy Staff Accountant Director of Pharmacy
340B Team
![Page 8: Dana RPh Director Pharmacy Rapid City Regional Hospital340bwinterconference.org/assets/uploads/02_04_345pm_Darger_1.pdf · Who Is Regional Health • Rapid City Regional Hospital](https://reader034.fdocuments.in/reader034/viewer/2022052419/5a7890cd7f8b9ae91b8c2c83/html5/thumbnails/8.jpg)
Policies and Procedures Definitions Operational
Audits Stewardship
Wholesaler Vendor Split Billing Contract Pharmacy Child Sites
Medicare Cost Reports Registration and Recertification Contracts or MOUs with Government Entity Contract Pharmacy Contracts
Compliance Program Key Elements
![Page 9: Dana RPh Director Pharmacy Rapid City Regional Hospital340bwinterconference.org/assets/uploads/02_04_345pm_Darger_1.pdf · Who Is Regional Health • Rapid City Regional Hospital](https://reader034.fdocuments.in/reader034/viewer/2022052419/5a7890cd7f8b9ae91b8c2c83/html5/thumbnails/9.jpg)
Patient definition Covered drug definition Duplicate Discount
Carve In or Carve Out Medicaid – your state Medicaid – other states
Exclusions GPO Orphan Drug
Contract Pharmacy Patient eligibility Contracting Duplicate discounts
What Are You Going to Audit?
![Page 10: Dana RPh Director Pharmacy Rapid City Regional Hospital340bwinterconference.org/assets/uploads/02_04_345pm_Darger_1.pdf · Who Is Regional Health • Rapid City Regional Hospital](https://reader034.fdocuments.in/reader034/viewer/2022052419/5a7890cd7f8b9ae91b8c2c83/html5/thumbnails/10.jpg)
Policy and Procedures When were they last reviewed or updated – ours is yearly, at a minimum
Are there gaps in what you do and the policies that you have Do you follow your policies
Patients Can you clearly demonstrate that only eligible patients are qualifying? Medical record Eligible provider
Self‐Audits
![Page 11: Dana RPh Director Pharmacy Rapid City Regional Hospital340bwinterconference.org/assets/uploads/02_04_345pm_Darger_1.pdf · Who Is Regional Health • Rapid City Regional Hospital](https://reader034.fdocuments.in/reader034/viewer/2022052419/5a7890cd7f8b9ae91b8c2c83/html5/thumbnails/11.jpg)
Split Billing Self‐Audit Frequency of Self‐Audits
DSH – Quarterly Randomly select 30 claims from each wholesaler account
CAH/Sole Community – 1 facility per quarter All transactions
Purchasing Can you track 340B purchases to eligible patients? Can you track WAC purchases to non‐eligible outpatients? Can you track GPO purchases to only inpatients
![Page 12: Dana RPh Director Pharmacy Rapid City Regional Hospital340bwinterconference.org/assets/uploads/02_04_345pm_Darger_1.pdf · Who Is Regional Health • Rapid City Regional Hospital](https://reader034.fdocuments.in/reader034/viewer/2022052419/5a7890cd7f8b9ae91b8c2c83/html5/thumbnails/12.jpg)
Contract Pharmacy Self‐Audits DSH quarterly contract pharmacy audits
Randomly select 30 claims from each contract pharmacy
CAH/Sole Community 1 facility per quarter – 30 randomly selected claims from each contract pharmacy
Eligible patients Medicaid exclusions? Billing, shipping and receiving
![Page 13: Dana RPh Director Pharmacy Rapid City Regional Hospital340bwinterconference.org/assets/uploads/02_04_345pm_Darger_1.pdf · Who Is Regional Health • Rapid City Regional Hospital](https://reader034.fdocuments.in/reader034/viewer/2022052419/5a7890cd7f8b9ae91b8c2c83/html5/thumbnails/13.jpg)
Independent Audit 3rd Party – outside vendor audit
Yearly
![Page 14: Dana RPh Director Pharmacy Rapid City Regional Hospital340bwinterconference.org/assets/uploads/02_04_345pm_Darger_1.pdf · Who Is Regional Health • Rapid City Regional Hospital](https://reader034.fdocuments.in/reader034/viewer/2022052419/5a7890cd7f8b9ae91b8c2c83/html5/thumbnails/14.jpg)
• Entity eligibility issues• Report to OPA• Stop purchasing
• Patient or covered drug eligibility issues• Repay amounts to manufacturers or determine the manufacturer’s preference
Reporting Self‐Audit Discoveries
![Page 15: Dana RPh Director Pharmacy Rapid City Regional Hospital340bwinterconference.org/assets/uploads/02_04_345pm_Darger_1.pdf · Who Is Regional Health • Rapid City Regional Hospital](https://reader034.fdocuments.in/reader034/viewer/2022052419/5a7890cd7f8b9ae91b8c2c83/html5/thumbnails/15.jpg)
$‐
$100,000.00
$200,000.00
$300,000.00
$400,000.00
$500,000.00
$600,000.00
$700,000.00
12/13 1/14 2/14 3/14 4/14 5/14 6/14 7/14 8/14 9/14 10/14 11/14 12/14
EOM Running Balance
EOM Running Balance
2 per. Mov. Avg. (EOM Running Balance)
Hmmmmmmmmm
![Page 16: Dana RPh Director Pharmacy Rapid City Regional Hospital340bwinterconference.org/assets/uploads/02_04_345pm_Darger_1.pdf · Who Is Regional Health • Rapid City Regional Hospital](https://reader034.fdocuments.in/reader034/viewer/2022052419/5a7890cd7f8b9ae91b8c2c83/html5/thumbnails/16.jpg)
Hmmmmmmmmmm
$0.00
$10,000.00
$20,000.00
$30,000.00
$40,000.00
$50,000.00
$60,000.00
$70,000.00
12/13
1/14
2/14
3/14
4/14
5/14
6/14
7/14
8/14
9/14
10/14
11/14
12/14
EOM Running Balance
EOM Balance 2 per. Mov. Avg. (EOM Balance)
![Page 17: Dana RPh Director Pharmacy Rapid City Regional Hospital340bwinterconference.org/assets/uploads/02_04_345pm_Darger_1.pdf · Who Is Regional Health • Rapid City Regional Hospital](https://reader034.fdocuments.in/reader034/viewer/2022052419/5a7890cd7f8b9ae91b8c2c83/html5/thumbnails/17.jpg)
Additional Questions?
Dana Darger, RPhDirector of Pharmacy353 Fairmont BlvdRapid City, SD
Phone: 605‐755‐[email protected]