Maximizing efficiency for pharmacy claims billing

The complex process of pharmacy billing involves submitting and processing insurance claims for prescription drugs and other pharmaceutical items. This procedure can be difficult and time-consuming, especially for independent pharmacy owners and managers who must juggle multiple responsibilities at once. In order to handle this process effectively, having a robust pharmacy management software backed by a support team that understands insurance billing is imperative.  The ability to stop or control losses, as well a get prescription claims paid quickly, will affect your bottom line as well as patient satisfaction with your services.

Pharmacy Software ease of use for billing claims:

Any pharmacy management system can ‘handle’ billing insurance claims for prescription drugs and other pharmaceuticals – but that is just the beginning.  How easy is it to use?  How long does it take to train your staff on how to bill these claims?  Verifying insurance coverage, filing claims, handling rejections and denials, updating patient insurance, the ability to bill COB claims as well as easy identify and repair issues — are all part of the day to day for any pharmacist or pharmacy technician.  When Datascan moved from their old DOS based system over to a Windows based pharmacy software, we made sure that efficiency was key.  The software displays the fields in order, one by one as you go through the fill process –without just displaying 20-30 fields on the screen all at once, like our competitors do.  The ability to fill prescriptions using only a keyboard and keystrokes — not requiring a mouse at all, was key.  The more information we could share about a patient, drug and doctor on the fill screen, the easier it is to quickly fill prescriptions in volume without having to bounce around to other screens or tabs.  The software has options for built in hard stops to help avoid rejected claims or audit issues later on such as a built in DAW check, confirmation of date written, and a series of color coded interaction and allergy warnings to avoid slowing you down.  Electronic prescriptions are filled with ease, minimizing keystrokes but also allowing for verification.  If a patient queues up an RX using the Datascan mobile application or by calling in through an IVR, it auto queues up in your central fill queue for filling in order that they came in.  A quick click of a button and the fill screen is up with most or all of the data needed to fill that rx.  The average user of Winpharm, our pharmacy management software, says they were comfortable and could easily fill prescriptions using our software with under an hour of training.

Focusing on speed, ease of use, the ability to quickly identify the status of a RX, or warning, the amount of data we present users at one time, and the field by field prompt have aided in our success and that of our customers for decades.

 Pharmacy System Features to avoid or minimize losses on prescription claims:

When you bill an insurance company (or PBM) for your patient’s prescriptions and get paid profitable, with no issues, sometimes it may feel like hitting the jackpot.  The number of reasons and rejections seems to grow every year.  Couple that with reimbursements below cost, at cost, COB claims, and even requirements for prior authorizations – and filling prescriptions just became a lot more complicated.

Built into Datascans pharmacy software, we have a number of features to make this entire process easier:

1:  Pre and Post Edits:  Our software has a series of pre edit warnings and checks to assist with preventing unpaid claims and audit issues in the future.  We also have a series of customizable post edit warnings that you can set to trigger such as paid at or below cost, paid equal to or above usual and customary (potential U&C issue), warn if you are paid a custom percentage off AWP, we allow you to require a minimum profit, and also have DIR thresholds you can set.  If any of these warnings are triggered, we stop the label from printing and the software color codes the prescription to warn of a reimbursement warning— so you can easily identify and work these claims to hopefully rectify the profit issue.

2:  DIR & GER Fees:  Datascan pharmacy software system has built in, DIR and GER fee estimators.  Not only can you report for a period of time to set expectations for these fees, but live, right after the claim adjudication is complete, we show you the range of payment based on historical fees for this particular insurance/pbm plan.

3:  Patient Profit Picture:  Winpharm has built into it, our patient profit picture.  This allows you to quickly see the historic profitability for each patient, include their family members purchase history, and this can display post claim adjudication.  So, if you are getting a negative reimbursement, you can dig into the profitability of the patient long term to see if you are losing money overall, or not making much at all.

4:  Organization and color coding of claims:  Whether you look in our daily log (of all prescriptions filled for a particular day), or in our organized To Do queue, any rejected prescriptions, or those stopped because of a reimbursement warning, are easy to identify and work through in an organized fashion.

5:  Automatic COB Billing:  Our pharmacy system has the ability to automate your COB claims and display both responses, as well as create ease of use for reporting and looking back historically at these claims.

6:  Automatic PA Submissions:   Datascan partnered with Cover My Meds years back to help automate the Prior Authorization process for prescriptions.  Now, when a PA rejection is received, the process is automatically started for you.  We put this into a queue for you to be able to manage and follow up on any PA’s that have not been responded to or resolved.

Pharmacy Software Vendor Live Support, and how it effects insurance claim billing:

Many times, when filling a prescription, you come across a rejection that you simply can not get past.  Patients need their prescriptions in a timely manner, and if your pharmacy can not deliver, you run the risk of another one taking that business away.  Pharmacy Benefit Managers and insurance companies are constantly adding requirements, and new rejections as to why a claim is not paid.  When all else fails, you need the ability to get help, and quickly.

When you call Datascan for assistance with any of our pharmacy software products, we typically answer the phone within 60 seconds or less.  Our staff is fully trained in all areas of our software, including claims adjudication assistance.  Even if we hit a wall getting your prescription paid with our knowledge base, we can get on a conference call with you and the plan to get things done!

In conclusion, it really is true that the right technology and company behind your pharmacy management system is the key to your success.  Employing pharmacy systems that are built efficiently, and help you quickly fill prescriptions is important, but equally as important is having a great support team that responds quickly.   We encourage any independent pharmacy owner to do a demo, read our reviews, and really find out what makes Datascan Pharmacy Software so different.