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Routine data analysis can be one of the most effective tools for navigating the complexities of the 340B landscape. Regular self-auditing can help ensure compliance, and even uncover new growth opportunities. This article explores how data analytics can transform 340B program management to not only meet regulatory requirements but also maximize potential savings.
Key Components of Self-Auditing
Regular self-auditing, ideally monthly, allows entities to stay ahead of potential issues; pinpointing underlying concerns that may affect claims capture such as outdated NDC blocklists or incorrect insurance carve-outs. With increasing manufacturer restrictions and the threat of audits looming, self-auditing becomes even more critical to maintaining a healthy and beneficial program.
It’s essential to look at your data on a regular cadence to identify patterns to spot outliers quickly, ensuring that only eligible claims are captured while minimizing errors. Providing detailed data back to stakeholders and reviewing configuration settings ensures that all aspects of your 340B program are aligned and functioning optimally.
Eligible Claims
A crucial part of self-auditing involves analyzing spend, eligible claims, and critical file maintenance components. By scrutinizing your overall claim capture statistics, covered entities can identify gaps and areas for improvement. This includes a detailed understanding of the claims processing information included in your data samples (for Instance, duplicates or reversals), and the intricacies of your program operation. For example, an 85% capture rate may prompt an investigation into the remaining 15% to understand failure reasons and enhance capture efficiency. If your eligible claims capture and spend is not currently meeting your expectations, routine auditing and analysis can aid in remedying tricky questions in a continuously evolving climate.
Patient Encounter Maintenance
Analyzing failed patient encounters is a crucial aspect of self-auditing. For instance, discrepancies between patient encounter dates and prescription dates can lead to claims mismatches and avoidable missed opportunities. Regular review of patient files and internal record-keeping procedures, often extrapolated through auditing and analysis, yields a significant impact on your 340B program and keeps larger concerns at bay. By identifying such issues, covered entities can correct data misalignments and prevent future capture failures.
Prescriber and Location Analysis
Unknown prescribers or incorrect location codes can cause claims to fall out, making it another vital component to your self-auditing process. By regularly reviewing and updating prescriber information and service locations, entities can improve capture rates and compliance.
Balancing Compliance and Opportunity
Self-auditing not only helps to identify vulnerable areas for compliance but can also reveal opportunities. For example, referral patterns may expose potential areas for expanding program benefits. By finding the sweet spot between compliance and opportunity through regular data analysis, covered entities can optimize their 340B programs for better financial and operational outcomes.
Conclusion
Staying vigilant and proactive in monitoring and auditing practices helps entities safeguard their programs and ensure they are maximizing their 340B benefits. By regularly analyzing claims, identifying issues, and uncovering opportunities, entities can enhance their program’s efficiency and effectiveness. Embracing these practices can help ensure compliance while fully leveraging the benefits of the 340B program.
Larry Crowder is Vice President of 340B Solutions at Cervey. He can be reached at lcrowder@cervey.com.
