
A claim
may be rejected for various reasons - incorrect drug selection, missing submission
clarification codes, mismatched quantity, or broken packages, etc. But whatever
the reason, it’s important to reduce error rates in a busy pharmacy. A rejected
claim here and there may not seem like a big deal, especially since the pharmacy
biller can resubmit the claim if the error is later identified. However, each correction
costs the team precious time to re-work the claim. And each subsequent claim
submission incurs additional transaction fees from both the switch provider and
the payer, so when there are multiple submissions for one claim, the time and fees
can add up and result in a significant increase in costs.
Of
course, not all claims get rejected. Many
claims are paid, but at a rate lower than the contracted reimbursement rate. In these instances, the pharmacy may never
know they were under-reimbursed. To
identify this missing revenue, they would need to review their claims after the
fact, find the errors, make corrections, and then resubmit the claim to obtain
the correct contracted rate. Not all
pharmacies have the staff to perform this function on a regular basis and for
those that do, this process delays the final payment, by weeks if not months, slowing
down the time it takes to get paid and negatively impacting cashflow for the
business. This is why it is critical for every LTC pharmacy owner to have a
system in place to catch and correct errors in claims before they are
submitted.
Work
Smarter, Not Harder
At Net-Rx, we recognize that LTC pharmacies
face unique challenges as they strive to meet the needs of the patients and
facilities they support, while also successfully managing their business. Our goal is to help LTC pharmacies get claims submissions right the first time,
resulting in increased cash flow and improved workflow efficiencies as well as
peace of mind knowing the dollars earned are paid at the contracted
reimbursement rate and have reduced
exposure to retrospective reviews and takebacks.
That’s
why we developed Script-IQ®,
a pre-edit component that complements our reimbursement suite of services. Script-IQ is a
solution custom-designed specifically for LTC pharmacies to transform the claim
quality checking process with the complexity of LTC billing and coding in mind.
Script-IQ integrates directly with a pharmacy’s dispensing software and enables
claim evaluation and correction to occur before the transaction hits
the switching system and payer adjudication process. Resolving issues before transmitting the
claim helps reduce the time spent on submissions and resubmissions, lessens
transaction fees, and maximizes reimbursement.
Read more about the Benefits of a Pre and Post Edit Solution