Optimizing Pharmacy Financials: Visante’s Impact on This Health System’s Pharmacy Revenue Cycle
The Path to Unlocking $8.1M in Revenue
This nonprofit health system serves communities across Northern Virginia and Washington, DC. Committed to excellence and driven by compassion, the organization prioritizes patient well-being through advanced healthcare solutions.
Leadership at the organization identified gaps between pharmacy operations, billing structures, and payer contracts that were leading to missed revenue opportunities. They sought a solution to optimize financial performance without disrupting patient care.
To address these inefficiencies, the hospital partnered with Visante to strengthen its pharmacy revenue cycle for medical benefits. The goal: achieve maximum reimbursement, maintain compliance, and improve overall operational efficiency.
The Challenge: Disconnected Processes & Revenue Leakage
The health system faced several challenges that hindered its pharmacy revenue cycle performance, including:
- Lack of integration between pharmacy operations and revenue cycle processes.
- Suboptimal billing structures that resulted in revenue leakage.
- Misalignment between contract terms and operational execution.
The Solution: A Comprehensive Pharmacy Revenue Cycle Approach.
To address these roadblocks, the hospital was in need of a strategic, data-driven approach. Visante conducted a structured assessment that included:
- Data Collection & Analysis: The Visante team aggregated financial and operational data to identify discrepancies, revenue leakage, and areas for improvement.
- Stakeholder & Employee Interviews: Cross-functional teams—including pharmacy, IT, billing, and revenue cycle management—were engaged in a series of interviews to gain a comprehensive understanding of process gaps and operational pain points.
- Operational Alignment: Payer contracts were evaluated to confirm that operational teams were following best practices to optimize reimbursement and maintain compliance.
- Revenue Code Realignment: Charge Description Master (CDM) records and medication coding were updated to align with payer expectations and reduce billing errors.
- IT & Billing System Enhancements: Critical system updates were implemented to improve claim submissions, reduce denials, and enhance overall billing efficiency.
“Our role was to bridge the gap between our client’s strong payer contracts and their operational processes,” shares Adrianne (Maxie) Friemel, Visante Senior Director. “This wasn’t just about fixing a few issues; it was a fundamental shift in how they approached pharmacy revenue. By the time we finished this project, we weren’t just consultants—Visante was seen as a part of the health system’s team.”
Implementing these improvements required coordination across multiple departments and external community hospitals. Aligning revenue cycle processes, billing IT, pharmacy IT, and payer contract teams was necessary for success. Effective change management allowed new procedures to be integrated without disrupting operations. Through collaboration and strategic focus, Visante helped the hospital navigate these complexities and achieve a seamless transition.
Tactics: Aligning Strategy with Execution
One of the most important elements of this engagement was achieving full alignment between our client’s pharmacy operations and revenue cycle team to capture every dollar of reimbursement. Visante implemented the following strategies to address key pain points and drive improvements:
- Medication Record Optimization: Every medication record was updated to align with new CDM standards, allowing for proper categorization and billing while eliminating potential inaccuracies.
- Claim Submission Overhaul: We redefined payer roles and streamlined the claim submission process, maximizing reimbursement and maintaining compliance with payer requirements.
- Revenue Code Realignment: The revenue codes were realigned to regulatory guidance, enabling our client to capture additional revenue streams that had previously been missed.
- Operational Coordination: We fostered stronger collaboration between the hospital’s revenue cycle, billing, and pharmacy teams. This coordination helped streamline workflows and provided clearer financial oversight for pharmacy.
- Stakeholder Engagement & Training: Visante collaborated with the health system’s leadership to prioritize necessary system updates. We also provided hands-on training for new team members to support the longevity of improvements and sustain the changes made.
Results: Our Client Unlocked Over $8 Million in Pharmacy Revenue Growth
Visante’s partnership led to measurable financial and operational improvements, including:
1. Revenue Growth
Our client experienced an $8.1 million revenue uplift post-implementation, capturing previously missed reimbursement opportunities.
2. Process Optimization
By streamlining workflows and improving coding accuracy, Visante helped reduce errors and improve alignment with payer contracts, leading to more efficient revenue capture.
3. IT System Enhancements
Optimized claim structures and improved alignment with negotiated contract terms significantly reduced claim rejections and denials.
4. A Trusted, Long-Term Partnership
Recognizing the value of Visante’s expertise, this health system continues to collaborate with the team for ongoing revenue cycle improvements.
“Our work with them went beyond revenue recovery,” says Friemel. “It was about building a smarter, more sustainable pharmacy revenue cycle.”
A Partnership for Long-Term Financial Health
The success of this project highlights the power of a holistic, data-driven approach to pharmacy revenue cycle management. Our client achieved immediate financial gains and formed internal connections for continued sustainability. By aligning operational practices with financial objectives, the organization optimized its revenue cycle, improved compliance, and enhanced financial sustainability—all while maintaining its commitment to high-quality patient care.
Is your organization ready to optimize its pharmacy revenue cycle? Contact Visante today to learn how our expert guidance can help you uncover hidden revenue opportunities and build a more sustainable financial future.