3 Ways to Curb LTC Pharmacy Billing Complexities
Prescription billing for long-term care (LTC) is inherently complex. LTC pharmacies are prone to billing challenges and intricacies that don’t come into play for retail pharmacies, which often make it difficult to operate efficiently and effectively.
Your ability to get prescription billing right is essential for achieving success in the LTC pharmacy space. However, from various billing models and payer types to complicated Medicare guidelines, LTC pharmacies must address a number of specific nuances to ensure they are reimbursed in full and on time.
That said, you can manage LTC billing complexities with the right strategy and technology to ensure accuracy and efficiency. Here’s how:
1. Invest in Pharmacy Software Designed for Long-Term Care
Pharmacy management systems designed specifically for long-term care can help resolve billing complexities and streamline workflows—and if you’re not already using LTC pharmacy software, it may be a sign it's time to upgrade to a more fitting solution.
Most retail pharmacy software solutions are ill-equipped to manage specific scenarios that come up often in long-term care, such as changes to billing preferences and payer statuses. Additionally, retail pharmacies typically fill and bill for prescriptions as they’re dispensed, whereas LTC pharmacies may need to fill at different intervals than they bill.
LTC-designed pharmacy management solutions like FrameworkLTC offer sophisticated billing features, allowing pharmacies to prepare their billing cycles in advance and to separate the filling and billing functions. Your solution should have the ability to support a variety of billing models used in long-term care, including:
Medicare Part A Billing: Medicare Part A will cover care at a skilled nursing facility after being discharged from the hospital.
Medicare Part D Billing: Medicare Part D is an optional prescription drug program that helps cover the cost of prescribed medications.
Medicare Part B Billing: Medicare Part B covers durable medical equipment (DME) when prescribed by your doctor or other health care provider.
Hospice Billing: End of life medication specifically billed to a hospice care plan
Per Diem Billing: Per diem billing follows a contractually agreed-upon daily rate for various medications and services, with or without exclusions.
Split Billing: Split billing allows for a single dispensing to be billed to multiple payers based on change in payer status, i.e. when a patient is covered under Medicare Part A and their payer status changes to Medicare Part D.
Short Cycle Billing: Short cycle billing allows the pharmacy to dispense medications in shorter increments, typically 7 or 14 days supply, as opposed to the traditional 30-day increments, and bill appropriately.
Pre/Post-Consumption Billing: Pre- and post-consumption billing separates the adjudication and dispensing functions, combining multiple fills into one claim.
2. Structure the Billing Setup Correctly from the Beginning
Without the appropriate setup, LTC pharmacies and pharmacy staff tend to struggle to get prescription billing right. However, if your billing process is set up correctly in terms of both workflow and technology, you can avoid potential data entry pitfalls, reduce unnecessary human error, and improve your LTC pharmacy’s billing accuracy as a whole.
Fortunately, unlike retail pharmacy management systems, LTC-designed solutions can be customized to ensure a patient’s payer status is appropriate for a specific period of time. Long-term care patients may have a variety of payment plans, including Medicare Part A, Medicare Part B, Medicare Part D, commercial insurance, hospice and/or private pay. In fact, most patients in LTC facilities are likely to use multiple billing models during their stay, depending on their coverage and particular treatment plan.
With the appropriate structure in terms of how you set up those various plans to trickle down from one plan to the next, the data entry technician does not have to worry about that structure. Instead, the system simply looks at the type of medication, the dates a patient is in a facility, or a particular payment plan to bypass plans when they're not appropriate, such as for over-the-counter medications that aren’t covered.
3. Ensure Adequate Training and Implementation Support
In order to effectively curb billing complexities that are unique to long-term care, it is imperative that your pharmacy software vendor provides comprehensive training and implementation support to get you up and running efficiently.
With extensive training and support available, you can build a successful operational and customer service workflow to maximize the full potential of your LTC pharmacy software. This process should include an in-depth review of your existing workflows and infrastructure, as well as comprehensive training.
FrameworkLTC’s implementation and training is an extensive program designed to ensure proper setup and training for your LTC pharmacy. Our comprehensive billing training coincides with your month end billing cycle to ensure the process is running smoothly and avoid any potential setbacks.
Curbing Billing Complexities with LTC Pharmacy Software
LTC billing complexities are significant—but with the right software, setup, and support, they can be navigated and overcome. Purpose-built software designed for long-term care pharmacies can help to streamline and improve billing processes, ensuring you’re submitting for reimbursement as accurately and efficiently as possible.
FrameworkLTC is a pharmacy management platform exclusively designed for long-term care. Using FrameworkLTC empowers LTC pharmacies to streamline their operations across the board—billing complexities included.
Curious about LTC pharmacy software and how you can use it to navigate dispensing, billing, and more? Schedule a demo to see how FrameworkLTC and the available add-on products can help transform your LTC pharmacy business for the better.