By Jennifer Gordon,
Product Lead, Net-Rx and Sarah Dean, Team Lead, Net-Rx
The outbreak
of the Coronavirus (COVID-19) has taken its toll on your patients, employees,
families, and businesses. Healthcare professionals around the world continue to
work tirelessly to support their communities. At Net-Rx™, a provider of
pharmacy reimbursement solutions exclusively for pharmacies, we understand the
complexity of working in a pharmacy, and that the everyday challenges now
include the extra weight of worrying about your and your staff’s health, and
how the current environment might impact your business.
During times
like these, it can be easy for changes in claim volume, medication shortages,
and coding errors to go unnoticed.
Patients who receive care in
nursing facilities are prime targets for coronavirus infection, which could
cause major changes to both claim volume and profit margins in the facilities
you serve. During this epidemic, we will see an increase in medication shortages
causing limited allocation on multiple medications, escalated over-the-counter
medication purchases, and 90-day fill requests. The combination of these will
likely cause challenges in inventory management.
Get ahead of potential
supply issues by fine-tuning your ordering practices. Frequently review your
top moving medications, profit margins, and claim volume. You can also check the
FDA
medication shortage updates for up-to-date information on medication
shortages.
Metric-Rx® provides reports that outline utilization, claim
aggregates, and profitability details for the facilities you serve, allowing you
to easily review trending data across all your pharmacy locations. For example,
the Ranked Drug report lists your highest-grossing and quickest moving
medications (month-over-month trending data) and can be generated at your
convenience.
Increases in the volume and complexity of prescriptions
come with an increased risk of workflow disruptions such as claim rejections,
overrides, and reimbursement challenges.
Coding on your claims must be
correct to receive accurate reimbursement. Some payers are currently allowing
the use of Submission Clarification Code (SCC) 13 for “Payer-Recognized
Emergency/Disaster Assistance Requested”. However, it is imperative that SCC 13
is only used when appropriate and per the payer’s specific directions. When you
receive rejections, we suggest that you contact the payer directly to verify
what coding they would like to see.
The Claims Data Extract Tool in
Metric-Rx provides reporting on over 55 claim elements, including Submission
Clarification Codes and Diagnosis Codes.
Here at Net-Rx, we have
multiple tools available to help your business stay successful during trying
times. To learn more about Net-Rx’s suite of solutions, visit https://www.net-rx.com/Products/Metric-Rx/. You
may also contact us at, Sales@Net-Rx.com, or 1-866-336-3879.
Next
Article: Why is Billing Prescriptions with an Accurate AWP Important?
REFERENCES:
MHA Coronavirus
(COVID-19) Online Information Repository
U.S.
Food & Drug Administration: Drug Shortages
Pharmacy
Times: Drug Shortage Concerns Are Top of Mind Amid COVID-19 Outbreak
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