How Understanding Your Hospital's Rev Cycle Boosts Your Career

Management

Become a more valuable asset to your pharmacy team.

Apr 10, 2024

Jessica Levco, Healthcare Journalist & Pharmacy Angle Contributor

Leonid Gokhman, PharmD, is a licensed, Epic Willow certified pharmacist who has more than 25 years of experience in the field of pharmacy. He has extensive experience in managing inpatient, ambulatory, and retail pharmacy operations, IT/informatics, value-added health economics, Formulary review/approval process, 340B Program, Medication Assistance Program, revenue cycle management, as well as managing both funded and unfunded patient markets.

For fifteen years, Dr. Gokhman has worked at the Harris Health System – a non-profit healthcare system located in Houston, Texas. For nine years, he’s managed the pharmacy business operations of the organization’s revenue cycle department. In his current role, he’s learned how crucial it is to have a pharmacist representation within the healthcare organization’s revenue cycle department.

Before his position, he said — much like the majority of pharmacists — he didn’t know much about the backend processes involved in medication billing, coding and reimbursements. As a frontline pharmacist, he was focused on his clinical work and patient care.

However, after learning about the inner workings of the revenue cycle processes, he’s developed a full understanding of the healthcare system’s frontend and backend processes. His knowledge and experience have allowed him to create and optimize all medication-related charging and billing processes.

This has ultimately contributed to more than doubling the organization’s cash collections, while saving millions of dollars through the 340B Program and medication assistance programs, and optimizing the organization’s Formulary.

Currently, he has three analysts working for him who are pharmacy technicians. He’s trained them to understand the system like he does. He shared a few examples of how being a pharmacist with knowledge about the revenue cycle can help your organization:

Discussion with Leon Gokham, Manager of Pharmacy Business Operations at Harris Health System (Part 1)

Get comfortable with data

Dr. Gokhman uses various KVI (Key Volume Indicators) and KPI (Key Performance Indicators) to measure his team, department, and the overall system’s progress, as well as identify areas of improvement.

Ongoing system maintenance and reviewing trends allows him to identify internal and external issues, and address them promptly with the necessary stakeholders through education and training. Ultimately, these activities allow the department to bill the claims on time, minimize denials and get paid faster.

Minimize denials

Once Dr. Gokhman learned about the inner workings of the revenue cycle department and how coding, reimbursements, approvals and denials are structured, he was able to implement multiple processes to minimize denials and ensure timely and accurate claim payments.

Additional factors, such as optimization of the financial system build, automation of medication charge posting, and accuracy of the medication chargemaster helped ensure that medication-related issues are kept at a low, manageable level and claim rejections/denials are minimized.

“We’ve been audited at least five times, and the findings were either minimal or none, which shows me what we’re doing is working,” Dr. Gokhman says. “My primary goal is to ensure compliance with all state, federal and billing regulations. Once the compliance is achieved, money usually follows.”

Negotiate better rates

Healthcare systems are complicated — and contracts are no different. Negotiated reimbursement rates ultimately drive what the organization gets paid for, and whether those rates are enough to cover expenses (profit) or result in a loss.

During his time at the revenue cycle department, Dr. Gokhman worked with the contract specialist to optimize the organization’s medical and pharmacy contracts.

“We've eliminated the ‘lower of’ terms from our medical contracts, which we had for a long time,” Dr. Gokhman says. “By eliminating this language (among other things), we were able to more than double our AR (Accounts Receivable).”

Advocate for better workflows

Frontline staff have a direct impact on the accuracy of charges populating onto a patient's claim.

“If the workflow is poorly designed, too difficult, or confusing, the frontline staff is likely to use workarounds and shortcuts, which generally result in missing or invalid charges,” Dr. Gokhman says. “These errors, if not resolved, will cause claim denials or rejections.”

A good example of a significant workflow improvement was the healthcare system’s Vaccine Redesign project. Before it started, the nursing staff had five different workflows and the charge error rate was extremely high.

After identifying the root causes of the problem, Dr. Gokhman worked with the organization’s IT department, nursing, physician, pharmacy operations and a few other stakeholders to standardize and consolidate all vaccine workflows into just one.

“Within three months of the implementation, the error rate went down drastically,” Dr. Gokhman says. “In fact, following the most recent vaccine billing audit, our organization was given 100% for the billing compliance. As a reference — the industry standard rate is 95%.”