The client is a large pharmacy with multiple locations in Northern and Central Illinois, caring for over 15,000 long-term care (LTC) beds for more than fifty years. They are both certified by the Accreditation Commission for Health Care in infusion and LTC pharmacy and provide services to nursing and assisted living facilities across the state. They also serve developmentally disabled clients and Community Integrated Living Arrangements (CILAs).
The pharmacy initially contracted with us to perform a system conversion. They were using a legacy system for pharmacy functions and document management but wanted to switch to Framework to better interface with automated dispensing systems. We helped make the conversion for 10,000 beds over 10 months.
After this successful experience, they partnered with us to support their everyday functions. Since then, our team of six patient access specialists has supported them with refill processing and profile-only new order entry for nearly 10 years.
Overloaded Pharmacy Billing Due To Complex Claims And Shifting Insurance Guidelines
With the challenge of constantly-changing formulary lists, evolving Medicare and complex insurance guidelines, the pharmacy billing teams often get overloaded. This leads to unnecessary mistakes and further lost revenue. The high volume of work and complex billing claims also make more and higher-skilled billing staff a necessity.
The client brought on a new billing manager who collaborated with our pharmacy billing team before. She was eager to work with our proven team again and tackle the challenges in her new billing department.
Infinx Chosen For Admissions, Census And Billing Support Services
Due to our existing relationships with the company and billing manager, it was a smooth and easy transition. Our team of seven billing agents helps remotely support admissions, checking that the pharmacy has all the general allergy and diagnosis information and necessary guarantor information from new clients. We also help with census updates, keeping track of changing rooms, discharges, and remaining Medicare benefit days. Lastly, we track all patient insurances and changing formularies, ensure claims are paid, and rework them when necessary.
We use an internal quality control software that ensures high-quality work and tracks the team’s productivity. Our team does the bulk of the behind-the-scenes work, which gives the pharmacy’s local staff extra time to provide improved patient care.
Minimized Overhead & Staffing Challenges Through Quality Third-Party Staff Augmentation
The client has been thrilled with the quality of our work. They find that our consistency is better than previous outsourced providers, as our oversight and quality controls prevent fluctuations or errors due to employee turnover.
Our team work covers off-hours and weekends, which are the more challenging times to staff locally. As the staff typically provides 24/7 services, these off-hours are essential. The pharmacy has also reduced overhead because our billing services are more cost-efficient than hiring locally.
In a market where employees are hard to come by, relying on third-party staff with skilled oversight to handle refill processing, admissions, census, and billing has been a significant relief to the pharmacy’s owner.
If you are looking to achieve similar results at your organization, contact us at www.infinx.com/request-a-demo.
Does your pharmacy struggle to find enough qualified staff to keep up with admissions and billing workloads? See how one Midwestern pharmacy uses remote support to stay on track.