Sentinel RCM™ is a comprehensive hospital pharmacy revenue cycle management application. Never before has a hospital pharmacy had the tools it needs
to truly track how drugs move through its environment, are purchased, and are administered to patients. Enhanced visibility brings more information to a
pharmacist or buyer’s fingertips and allows them to save money and time.
Sentinel RCM™ provides the DRAtool™ as a module to assist your organization in maintaining compliance to this detailed new requirement.
Automation Eases the Burden
Sentinel RCM™ and the DRAtool™ automatically solve the incredible challenge of mapping over 6,000 J-Codes and Q-Codes to the correct NDC that was previously purchased, recording the correct acquisition cost (if applicable), and converting the units to the correct billing units.
The DRAtool™ focuses your attention on those exceptions that occur, and monitors your operations to alert you to claims and billing events that require further attention.
Unique DRAtool™ Advantages
- The DRAtool™ provides full visibility to your environment, and seamlessly stitches together all requirements into a real time, highly visible audit trail.
- Documented Polices and Procedures are digitally enforced by an advanced compliance rules engine.
- Provides true tracking of multiple Drug Charges (dispensations) to multiple Drug Purchases (NDCs) via the Formulary Matrix
- Adds the correct NDC and quantity to the Medicaid 837 (or other format) claim automatically.
- Proactive alerts focus a user’s attention on billing exceptions or issues.
- Web delivered, lightweight, secure application is accessible and easy-to-use.
- As regulations and requirements are updated, reconfiguration is simple and accomplished by updating rules, not costly application reconfiguration.
- Can accommodate multiple locations, charge masters, wholesaler accounts, and inventories.
Avoid Common Pitfalls with the DRAtool™
Errors can be costly, and can occur in several key areas:
- An NDC can be reported on a claim for a drug that your institution never purchased.
- An NDC can be reported on a claim for a drug that was never dispensed to that particular patient.
- The incorrect billing amount (or acquisition cost extension) could be reported due to an outdated or inaccurate Charge Description Master.
- Even if these errors don’t occur, an entity fail to maintain adequate records which prove compliance in the event of an audit, thus exposing an entity to unnecessary and time consuming risk.
Each of these issues can be caught as exceptions by the DRAtool™ and further examined by staff using a combination of actionable reports and alerts.
- Execute on adopted, documented, electronically enforced Policies and Procedures.
- Provides documented 11 digit to 11 digit NDC rule compliance for 340B replenishments.
- Preserves the complicated GPO Exclusion Rule.
- Captures additional savings opportunity due to rich data environment available.
- CDM-NDC crosswalk retention to evidence historical compliance.
- Provides a seamless end-to-end audit trail.
- Identifies and tracks billing codes against drug purchases which detects leakage, purchase/utilization discrepancies, and missed J-code billing opportunities.
- Provides 80/20 reports, top utilization reports, and other analytics to assist you in managing your inventory, formulary, and purchasing.
- Fully integrates medstation and other automation feeds to provide full visibility, regardless of technology used in medication distribution.
- Seamlessly manage your on shelf inventory and any virtual inventories.
- Auto-calculates Min, Max, and Par levels based on previous historical usage. These can be specified by drug charge, NDC, or therapeutic class.
- Setup formulary policies based on price, account, contract, bottle type, and dose type.
- Inventory can be reconciled and tracked electronically across multiple accounts.
- Seamlessly integrates with Mobile Manager™.
- One click generates an on-shelf cost based on policies and procedures.
- Stratifies claims based on benchmarks and published coverage guidelines, and identifies outliers categorized by risk.
- Identifies areas of missed billing opportunity based on identifying “orphan” charges and mapping inconsistencies.
- Provides documentation of actual costs matched to submitted charges on claims.
- Flags fluctuating reimbursements for procedures by payor, provider, and location.
- Operates on 837s, UB92s, HCFAs, and can accommodate custom formats.
- Provides executive dashboard of activity and key contract performance indicators to serve as a basis for renegotiation of payor contracts.
- Integrates electronic ordering, receiving, and inventory reconciliation from a wireless handheld device, coordinated via Sentinel RCM™.
- Scan and/or assemble drug orders using lightning quick catalog searches and see your order allocated in real-time on the handheld.
- Easily place orders wirelessly, no need to synchronize with a base station.
- Perform catalog and price lookups via a scan or a lightning fast catalog search.
- Device utilizes any existing wireless infrastructure.
- Identifies pricing discrepancies within wholesaler accounts.
- Tracks price paid vs. price quoted.
- Tracks price paid vs. national averages.
- Identifies inaccurate or missing price loads.
- Automates dispute initiation and tracks resolution.
