How to Clean Up Infusion Billing Messes

Much like a broken bone, issues surrounding the billing process will remain unresolved until they receive the proper attention. On another episode of The Modern Healthcare Back Office, Tina Ratliff, a Pharmacy Reimbursement Manager at Prochant, explains how infusion pharmacies can quickly improve their billing process.

There's no benefit to being conscious of a problem if you're oblivious to what's causing it. Therefore, discovering the bottleneck or where the issue is coming from is the first step pharmacies need to take to improve their billing process. After identifying the inefficiencies, prioritize corrections based on which changes will have the most positive impact on your bottom line. Instead of billing, sometimes the inefficiency is a training issue.

Proper Training

During the diagnostic process, it's imperative to work alongside employees so you can ask them why they complete specific tasks a certain way. You can't confirm whether or not your approach to executing a particular task is superior unless you are aware of the other individual's reasoning behind their actions. When you're explaining your way of doing things, explain why, not just how. People are more open to suggestions when they are paired with a detailed description. 

Employees are more likely to embrace integrating a system when they buy into it, as opposed to it being forced upon them. After explaining how to carry out a particular task, go back a week or two later to confirm your employees are still following your instructions.

Have Contracts in Your Software

From a software standpoint, having contracts in your billing software is the most beneficial action a biller can take. A contract is an arrangement with your payer. It's an agreement on what's billable, what isn't, and what percentage the payer and the patient will cover individually. Once the contract is in the software, it removes human error from the equation when calculating prices. 

Look at Denials

If you were to bypass the diagnostic stage and focus entirely on billing, trending denials would be the ideal place to start. Look at what isn't being paid and figure out the best course of action to bring that to resolution. If a contracted payer isn't covering a specific drug, you can receive the outstanding funds owed to you by meeting with a provider relations representative and proving they aren't holding up their end of the deal.

Unfortunately, your current billing process issues aren't going to miraculously disappear unprompted. However, the sooner you recognize the inefficiencies and start repairing them, the less time it will take to turn things around. The full in-depth analysis can be listened to below:


To learn more about how Prochant helps infusion providers, visit our infusion solutions page.

Prochant has a proven track record of helping pharmacy and HME providers meet their financial goals. Our scalable solutions, years of experience, and advanced technology provide best-in-class results to the healthcare community. Headquartered in Charlotte, North Carolina, our client base includes national pharmacy and HME providers and health systems.