Today’s Independent Long-Term Care (LTC) pharmacies are grappling with adverse financial shifts from a rapidly expanding elderly population, increasing use of generics, drug cost inflation, and continuously changing governmental regulations.  It’s more important than ever to examine operational flow and the entire billing lifecycle to ascertain where additional efficiencies might be gained.

Many independent LTC pharmacies are expanding from additional LTC residents, homes, or acquiring another pharmacy company; the challenges grow exponentially.  Deploying demonstrated tactics by partnering with a third-party team may be the ideal solution for navigating future changes and expansions.

10 Proven Strategies to Improve Your LTC Pharmacy Revenue

Each step of the process can provide operational improvements and direct contributions to the bottom-line.  Factoring in the efficiencies of a third-party partner supporting you through the Pharmacy Information System (PIS) allows you flexibility while leaving the scaling issues up to them.  Let’s examine the flow, as well as the challenges brought with expansion:

Order Entry

Starting at the beginning, where accurate, precise entry dictates downstream revenue capture, your partner’s team would be able to access arriving orders and enter them efficiently and accurately into the PIS.  This information is the foundation for proper and accurate dispensing, as well as regulatory compliance.

Triage

Critical to patient care is the ability to determine when urgent requests have arrived and to expedite those prescriptions promptly.  Using the specific protocols dictated by your organization, your partner’s highly-trained staff would accelerate urgent requests ahead of the routine prescriptions, adding annotations or run times, to ensure the appropriate emergent response 24/7.

Prescription Refills

Refills would be managed according to an assigned protocol, including rejected claims, early refill requests, and duplicate orders, 24/7 to ensure maximum efficiency and meet delivery runs throughout the day.

Pharmacy Billing

The LTC pharmacy billing lifecycle is a complex process where your third-party partner would provide the scalable support your billing team needs to ensure timely reimbursement.  From prior authorizations to payment posting to census maintenance, your team working with a partner group would guarantee smooth, efficient revenue workflow.

Admissions

Critical to the ongoing dispensing and revenue management functions is the accurate and precise admissions process that initializes a patient account in the PIS.  From patient demographics and insurance/benefits eligibility to allergies to diagnosis, each component must be exact to ensure success.

Daily Census

Matching patient prescription plans to actual patients and their physical locations is a challenging, ongoing process that is managed through the PIS.  Having a third-party partner able to work the daily census reports, including admissions, discharges, room changes, etc., in a scalable way, helps ensure ongoing efficiency.

End-of-Month Processing

In the complicated healthcare reimbursement process, a critical step in LTC pharmacy billing is reviewing the month-end census and making corrections or modifications where needed.  With a third-party partner, this process can be completed on a quick turnaround with increased accuracy by highly-trained billing specialists.

Specialty Pharmacy

Often with specialty prescription requests, there will be insurance payer requirements that must be facilitated to guarantee payment.  Using a partner team that automates this process with AI-assisted software, prior authorizations can be initiated, submitted, and followed up, all while keeping your staff informed through an integrated link to your PIS.

Technology Solutions When Converting PIS Systems

When needing to upgrade to a new PIS system, the electronic data conversion can be overwhelming and require unmanageable overtime expectations or temporary personnel with limited knowledge.  By utilizing a focused, experienced third-party partner with extraction systems in place, your data can be migrated seamlessly with little or no downtime.

New Facility On-Boarding

And finally, when onboarding new facilities, your go-live date is always preceded by significant crunch time.  Off-loading the entire process, with the help of your partner team, allows you to assimilate new homes and patients consistently and smoothly with little disruption of the day-to-day activities for existing facilities.

 

LTC pharmacies are facing unprecedented changes…and opportunities…in the industry with consolidations, changing regulations, and pricing/reimbursement pressures.  Bringing the extra strength of third-party resources can help to manage the complexities and improve your bottom-line results.

To learn more about optimizing your LTC Pharmacy RCM, contact us to schedule a demo or conversation!