Our LTC pharmacy customer serving over 55,000 patients in nursing homes and other care facilities on both U.S. coasts required some immediate financial belt-tightening within their internal operations. One area they first looked at was their billing department. Typically operating at a higher end of the pay scale than other pharmacy staff, billing specialists tend to operate in a separate “bubble,” apart from other functions. Due to those higher costs, any improvement Infinx could provide would have a stronger impact on the bottom line.

The Focus: Solve Critical Pharmacy Billing Needs

As Infinx already successfully managing the customer’s refill operations, we were considered a safe bet to revamp and improve much of their day-to-day billing responsibilities as well. We developed a plan to assume four critical billing duties:

  • Daily Recording and Mid-Month Censuses
  • Off-Hours Admission
  • End-of-Month Censuses
  • ‘Pending Medicaid’ Review

Eliminated Errors by Recording Daily Admissions Data and Preparing Mid-Month Censuses

The Infinx pharmacy team took on the added responsibilities of accurately recording daily admissions, room changes and discharges, while correlating prescription data for each. This also involved facilitating new arrivals’ temporary coverage by Medicare Part A, where applicable, before transitioning to full-time Medicaid, Medicare Part D or private insurance. Mid-month censuses reviewed the accuracy of these daily entries in advance of the end-of-month censuses.

Improved Data Entry Through After-Hours Admissions Staffing

Many admissions and discharges occur outside standard 9 to 5 business hours – sometimes as late as 10 p.m. Infinx data entry specialists provided the added flexibility for after-hours admissions staffing, ensuring accurate data entry, insurance coding and processing refills and eliminating nagging paperwork backlogs while keeping all patient data up-to-date.

Reduced Costly Overtime with Error-Free Record-Keeping and End-of-Month Censuses

The customer’s in-house billers at every facility were routinely swamped between the 1st and 10th of every month, reconciling monthly censuses to match daily patient records. As this final census needed to be painstakingly double-checked before payers were billed, it routinely required long hours (with costly overtime) for in-house staff. Infinx devoted additional pharmacy data management resources to reconciling the end-of-month census delivering error-free monthly records within a shorter timeframe.

Solve Retro-Billing Issues by Tracking Patient ‘Pending Medicaid Review’ Statuses

When new patients are admitted to facilities, they are initially covered by Medicare Part A for up to their first 90 days. If it becomes clear they will require permanent care, they will transition to full-time Medicaid. Yet most state Medicaid programs will not proactively notify providers of patient statuses, leaving them to monitor them on their own during the transition period. With multiple patients on such a “pending Medicaid” timeline, staying on top of it all was tricky. Our team maintained a running report of pending Medicaid patients, enabling the customer to more easily retro-bill for high-priority prescriptions and other pressing patient needs.

The Result: Improved LTC Pharmacy Billing

Following our successful account expansion from refill management into billing operations, the customer has noticed a steady uptick in efficiency, at significantly lower man-hours and overall costs.

Learn more about Infinx and our LTC pharmacy management solutions.