With the year coming to a close, it’s the perfect time for infusion pharmacy back offices to look at what can be improved. Tina Ratliff, Prochant’s pharmacy reimbursement expert, spoke on The Modern Healthcare Back Office podcast about the five resolutions providers should make for 2023. From eliminating bad reimbursement habits to learning how to better close out the year, here is a recap of what was discussed.
Eliminate these common bad habits from your back office:
- Bad Habit #1: Using manual processes. If you have a billing-type software that can do these processes for you automatically, use it. Though the initial setup can be time-consuming, it will minimize human error and save revenue.
- Bad Habit #2: Copying previous claims, even if it seems like it saves you time. Instead, make sure you are billing for exactly what was dispensed in each delivery.
- Bad Habit #3: Overbooking revenue. New year, new revenue! Make sure your pricing set up in your billing software or fee sheets are the most up-to-date. If you’re able to put them into your software so they can price automatically, do so to eliminate guesswork.
- Bad Habit #4: Missing information in your billing system. If your system has a way to store information so it’s at everyone’s fingertips, set this up. Make it so you don't have to manually create claims or calculate billing units on drug strengths.
- Bad Habit #5: Following outdated guidelines. Tina has seen so many pharmacies do extra work just to make sure claims go out. Besides the time-constraining issue, sometimes, a payer will change their requirements without telling you, but still let you continue to do all the extra work even though it’s no longer required. Consistently ask payers how you need to make claims in order to weed out unnecessary steps.
Make the 1% Improvement.
If you master continuous improvement and get 1% better each day for one year, you’ll end up 37 times better by the time you’re done. We start every year with big goals and long lists of things we want to improve. Fairly quickly, we fall away from our goals. To truly improve in a realistic way, take it one day, one percent, at a time.
For example, let’s say we want to fix our Denial Rate. It’s currently at 18%, but in 2023, we want to have 5% or less denials. What usually happens when you hand that goal over to the team to help you meet that goal, they feel overwhelmed and unconfident right from the start.
To fix this, help them change perspective. Ask the brainstorming question: “How can we break this down into tiny pieces to make it better every day?” To continue with the above example, take your top denial for your top payer and work on it every day for a week until it’s done and then you move on.
Focusing on all the things that need to get done won’t help you fix any one thing faster. Work on one thing at a time to improve your results day by day.
End-of-year benefit investigations
Be prepared to check benefits for all active patients before you dispense again. Being able to do this electronically is helpful. The patient portal could give you the information you need as well to make sure the patient is still active with the benefits.
Checking benefits once a month is best practice. Doing small batches of patient checks makes it easier at the end of the year to not do 100 patient checks manually at once.
New process changes
The end of the year is a great time to get new processes in place. If you’ve wanted to get rid of your fax machine to use less paper and go electronic, now is the time to find an electronic fax provider. If you want to revamp your intake or billing team, decide now what new process can be put in place when it comes to looking at new patients.
Take the moment now to also look at deploying new software or an analytics platform to make storing documentation easier and track your revenue metrics better.
Get ready for the end-of-year close.
Start your year-end process now. For 2023, create a goal to make checks throughout the month to not have to worry about the monstrous end-of-year closing period. For example, a soft close at the end of the month or even weekly will help you know right away that your revenue makes sense and adjustments are good. No more staying at your desk until midnight trying to balance cash. Stay in balance by treating every day as “year end.”
If you have any questions about infusion back-office processes, please feel free to email Tina Ratliff at firstname.lastname@example.org or message her on LinkedIn. Our other back-office processing expert and The Modern Healthcare Back Office co-host Rachel Schools can be messaged on LinkedIn as well here.
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.