![]() Finally, ensuring billing compliance, including ownership of the pharmacy charge description master and maintenance of electronic health record medication lists, is vital in preventing charge and reimbursement errors. Optimizing revenue capture involves a combination of clinical expertise and understanding of billing operations to ensure medications are being billed and reimbursed appropriately. Minimizing revenue loss is accomplished primarily through management of pharmacy charge denials and can be an ideal first step in establishing a PRI program due to the tangible value generated. The activities of a PRI program can be grouped into 3 main pillars: minimizing revenue loss, optimizing revenue capture, and ensuring billing compliance. This article provides a framework for establishing a PRI program and reports results generated from it. This team has been able to significantly reduce revenue loss from denials, increase billing compliance, and improve revenue capture. At UNC Health, a dedicated pharmacy revenue integrity (PRI) team has been operating since 2017. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.Īn increasing focus on driving margin has pushed health-system pharmacy departments to find new ways of generating new or protecting existing revenue. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. ![]() In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance.
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