There is never a bad time to make your intake processing run smoother! To help infusion providers with their front office, Prochant’s Pharmacy Reimbursement Manager Tina Ratliff held a webinar hosted on The Modern Healthcare Back Office podcast that includes an overview below. Read up now on the three key areas where most mistakes are made during intake processing. Many of the discussed tips are also useful to just about anyone working in a healthcare industry front office.
The most important thing to the infusion back office is intake. Intake is occurring during the time when you’re making sure your patient qualifies for the services and products being requested. It’s when a provider is checking that all medical records are available to make the billing process easier.
Key Area #1: Eligibility Checks
If you're dealing with a brand new patient, try calling instead of running an electronic check when it comes to checking eligibility.
Reasons why Prochant suggests this:
- There is no option just for home infusion specific benefits on patient portals.
- You want to be able to ask important questions to make certain you’ll get reimbursed (i.e. “Is there a specific pharmacy that needs to supply this drug?”).
- If something a representative says sounds incorrect, trust your instinct. Ask to speak with another representative who will hopefully know better.
- Call the authorization department even if the representative says the authorization is not required (especially on high-dollar drugs).
- If the representative you’re speaking with is giving push back on directing you to the authorization department, ask to speak with the authorization department about a predetermination on a patient.
Key Area #2: Medical Records
The easiest time to get your medical records in order is during the time of intake.
- Upon receiving the receipt of a referral, verify all records supporting the diagnosis and verify things like patient IV access. Get everything you need ahead of time.
- Verify that the patient meets criteria for the prescribed drug and also confirm there isn’t a preferred alternative product for that payer.
Key Area #3: Authorization
When it comes to authorization, have all the codes and units you’re going to bill ready to go.
- Plan ahead for your expiring authorizations. Go in and make sure patient records and treatment notes are current.You also want to make sure the order is current and won’t expire by the time you do your re-authorization.
- Work on having good communication between the authorization team and the pharmacy when an order is changed.
- Record all the information you are given by the benefits and authorization department. You want to have all the proof available if you need to send an appeal.
For a more in-depth discussion on these tips for the infusion front office, watch the webinar below. If you have any questions about infusion reimbursement processes, please feel free to email Tina Ratliff at firstname.lastname@example.org. To learn more about Prochant’s pharmacy reimbursement solutions, visit here.
Prochant has a proven track record of helping HME and pharmacy 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.