Reversing 5 Bad Habits in Infusion Revenue Cycle Reimbursement

Big or small, bad habits in revenue cycle reimbursement can become frustrating when we can’t break them. Typically, you’re more likely to eliminate bad habits when you have a definitive action plan for removing them. Prochant infusion pharmacy reimbursement experts understand the detrimental impact unnecessary production inefficiencies have on pharmacies. Here is how to identify and break five common bad habits in infusion pharmacy revenue cycle management.

Bad Habit #1: Not recruiting the right people 

One of the most important factors for determining the success of a pharmacy is hiring the correct people for your team. However, finding the ideal candidate for every position is a challenging task. Not only do you need an individual who’s qualified for the role, but they also need to possess qualities that align with your workplace environment and culture.  

When hiring new employees, seek out candidates with industry experience, the ability to adapt, and strong communication skills. While one’s skills can improve on the job, their attitude and work ethic remain consistent over time. If an applicant lacks work experience but appears highly motivated, malleable, and fits your work environment, they’re worth investing in over someone who isn’t ambitious and adaptable. 

Bad Habit #2: Following an outdated intake structure 

If you face an accounts receivable (A/R) problem, it’s crucial to find the area experiencing the issue. Begin with intake and develop a standardized system. Make a template your employees can use to document intake regularly. This is particularly beneficial for patient registration. 

Furthermore, it’s essential to dedicate additional attention to insurance verification, as it frequently decides whether or not you get paid. Prochant revenue cycle reimbursement experts also recommend verifying insurance for each new patient or new therapy and ensure codes are covered and the individual has infusion benefits. Make a point to provide comprehensive information on your insurance verification forms for documentation purposes. 

Effective communication is vital in the workplace. When dealing with prior authorization and prescription processing, concise communication is necessary between your various departments and when making exchanges with your insurance representatives. Regardless of the system you utilize, make sure accurate coding is applied and that any modifications are effectively communicated to the relevant department. For instance, the infusion billing department must be notified about any code changes before submitting a claim. 

Bad Habit #3: Being behind on code changes and payment tracking 

Coding precision in infusion billing is an additional obstacle infusion pharmacies are up against. Considering code changes happen periodically, it’s pivotal to stay up to date on these advancements. Fortunately, there are significant resources available that facilitate this information. Companies will host webinars or upload newsletters that help providers stay up to date on changes as they arise. By utilizing these types of resources, you can assure your team has the knowledge and ability required to take on coding properly.  

Prochant’s infusion pharmacy reimbursement experts are hosting a live webinar on November 14 for providers entitled, “Reimbursement Simplified: Solving the High-Cost Labor Shortage in Today’s Infusion Pharmacies.” Register here!

Another billing difficulty is centered around payment tracking. Whenever feasible, opt for electronic processes, generate verifiable records of filing, and upload documentation via patient portals. All of these measures contribute to the prevention of claim denials. Most imperatively, post your denials. This is crucial when assessing your metrics. Posting denials will allow you to locate trends in your key performance indicators before your A/R rate takes a sizable hit. 

Bad Habit #4: Too many denials left unmonitored 

Claim denials can offer valuable information into your team’s production levels and serve as an indicator of discovering potential problems. As soon as a claim gets denied, assign it to an employee to increase the probability of your infusion pharmacy getting paid. Remaining diligent and conducting weekly denial reviews by type, payer, and reason will help you stay up-to-date and delve deeper into any problems. 

Tip: Look for trends in your denials. If you detect an increase in denials from a particular payer, consider it a red flag that suggests there may be an underlying issue that requires attention. Occasionally, a payer changes systems and has to reload your contract, but they do it incorrectly.  

Keep an eye on your denials. If you’re consistently receiving the same denials, it means there may be an issue with your processes, or a payer could be doing something wrong unbeknownst to them. Continue monitoring trends to proactively extinguish small problems before they develop into major obstacles that prevent you from getting paid.  

Bad Habit #5: Copying previous claims & unnecessary manual processes 

Invest the necessary effort into learning how to optimize the software you use. Doing so will help your business from making tasks harder than they need to be. Utilize software to calculate drug units instead of doing it by hand. The manual approach can cause overbilling and underbilling, often without the provider’s knowledge.  

Configure your system to automate specific processes. One of the key benefits of automation is its ability to prevent human errors. When copying previous claims, make a point to start fresh every time. Copying past claims increases the likelihood of an error occurring when billing units. New claims may include new or revised data that differs from the previous one. 

Breaking free from these poor habits is essential for any pharmacy looking to maximize their output. Addressing these bad habits and implementing the suggested changes can drastically improve the efficiency and profitability of your infusion pharmacy over time. Your commitment to improvement by breaking bad habits will lead to more favorable outcomes, not only for your business but also for your patients.  

Prochant is the only AI-driven reimbursement service provider in the home-based care industry. We deliver focused revenue cycle management (RCM) solutions to healthcare providers with 7 wholly-owned global delivery centers. Our expertise lies in providing end-to-end RCM for home-based care, infusion, and specialty pharmacies, consistently delivering exceptional results to some of the leading healthcare providers in the country. We harness specialized automation technology and deep industry knowledge to streamline the time-consuming and expensive reimbursement process. As a result, we help healthcare providers accelerate their collections, increase revenue, and reduce operational costs while managing risk. Prochant is HITRUST certified, the gold standard for HIPAA security.