Turning data into an asset
As a pharmacist, you can’t know all of your prescribing providers. While most are legitimate, it is necessary to verify provider licensing and credentials to identify prescribers with inactive or expired licenses or even potential criminal entities.
Provider verification is a vital part of successful pharmacy operations and patient safety. Pharmacists depend on accurate, current data about both patients and prescribers; it’s their greatest asset. Additionally, failing to appropriately verify prescriber data can result in costly fines by the Drug Enforcement Administration.
Maintaining integrity of pharmacy data requires constant stewardship. Here’s what you need to know about how inaccuracies and inconsistencies can plague pharmacies, and what you can do to maintain provider data accuracy.
The problem of changing data
The Greek philosopher Heraclitus said, “The only constant in life is change.” What’s true in life is true in data: it’s constantly changing. According to LexisNexis Risk Solutions, active healthcare practitioner data changes in only one week include the following:
- 33,000 primary addresses,
- 3,300 names,
- 1,750 phones
- 1,500 fax numbers,
- 86,000 state license expirations,
- 17,000 state license statuses,
- 7,000 qualifiers, and
- 1,000 DEA numbers.
In addition, some prescriber addresses in pharmacy systems are not considered acceptable and deliverable by the U.S. Postal Service. Other data is compromised by variations in credential acquisition by state and board, credential requirement and recognition differentiation, data availability and data quality control, as well as federal and state standardization inconsistencies. Often pharmacies dedicate many staff hours to navigate various systems to crosscheck vital information. This loss of manpower is significant, and is generally considered a “workaround” process versus a long-term solution for maintaining data integrity.
The benefits of automation
Inconsistencies and erroneous or outdated data remain major challenges for retail pharmacies nationwide. You are certainly not alone. Many pharmacies find they are “spinning their wheels” to solve an ever-expanding problem, dealing with the fallout of compromised quality and poor resource allocation. Manually checking provider data on federal and state websites takes multiple steps, leaving room for error and inefficiency. It’s also a very reactive approach to managing information-powered functions, in general. Payer payment recoveries can also happen in case of errors, having further financial impact on pharmacy operations.
An alternative approach to manual verification is automating verification and monitoring of healthcare provider licensing and credentials. Comprehensive batch and real-time technology solutions can streamline a variety of provider verification searches and ongoing monitoring options and provide automatic red flag alerts for a wide range of high-risk indicators.
The scope of provider data challenge facing pharmacies is significant. It’s a frequent area for mismanagement which often results in both fraud and improper payments. If your pharmacy’s data deluge feels out of control or simply requires a major clean up, start with improving prescriber data accuracy now.
Jill Regan is the director of relationship management at LexisNexis Risk Solutions - Health Care