Long Term Care Pharmacy
Prior Authorization and RCM
Capture more revenue with solutions for prior authorizations, Rx processing, billing, mail order services, and support.
The Challenge
Improving Accuracy
High-volume prescription processing can turn your pharmacy into a three-ring circus. If your pharmacy serves long-term care facilities, you know that handling large volumes of prescriptions on schedule requires quick, clean order processing. Every prescription requires a careful eye on policies, procedures, and detailed regulations. If you are managing growth, adding on new long-term care (LTC) homes, or acquiring another pharmacy, your challenge is even greater.
Infinx helps you preserve revenue through the entire patient stay by ensuring proper claim processing and billing.
LTC Pharmacy RCM Solutions Include:
Order Entry
We will access arriving orders, and enter them according to the rules and protocols specific to your pharmacy. That includes Priority, Run-Time, and Cut-Offs. Medication orders are entered into your Pharmacy Information System precisely as your staff is doing currently.
Triage
We review all documents arriving into your document management system, and sort in real-time based upon department and priority. This includes adding run-times or other annotations needed to ensure proper handling of the documents.
Prescription Refills
New or refill orders, whether arriving electronically or via fax are processed one at a time following pharmacy guidelines. Rejected claims, early refills, duplicate documents and cycle meds are all handled appropriately by the team to ensure the patients get all the medications needed on time. Infinx can work this overnight as well to help the pharmacy get the maximum number of refills on the morning runs.
Pharmacy Billing
We will work side by side with your billing team to help manage the daily volumes of work, including intake registration, insurance eligibility, prior authorization, census maintenance, payment posting, and Medicaid pending status check.
Admissions
Our team will review all admission documentation, set-up patients in the system with demographic information, allergies, diagnosis, guarantor, and payment plans. Eligibility searches are performed to ensure all plans are found and added.
Daily Census
We work the daily census documents received from the facilities, updating admissions, discharges, hospital leaves, bed holds, room changes, and coverage changes. They will also adjust claims already processed to ensure proper plans are being billed on the correct dates.
End-of-Month Processing
For end-of-month census, we will review all monthly claims to ensure they are billed to the correct payers while working with your team to help get them completed in a timely fashion.
Specialty Pharmacy
We will verify that a prior authorization is required, initiate and submit the request, follow-up on the status of the claim, and update your system. Our insurance verification team will confirm patient medical and pharmacy benefits with accuracy and quick turnaround times.
Technology Solutions
Our electronic data conversion team will automate the extraction of data from your previous pharmacy system and migrate it to the new pharmacy system seamlessly and accurately. Our experienced team of programmers can custom write software to suit your needs including UX and UI design.
New Facility On-Boarding
When you grow your business, we will help you get those new patients into your system and ready to be filled in time for the go-live. 100 percent of internal QA ensures the highest quality patient set-up and order entry of both medication and ancillary orders.
Whether your pharmacy relies upon FrameworkLTC, QS1, HBS, Helix, or any other pharmacy management software, our order and billing specialists seamlessly dovetail with your current operations to ensure speedy, accurate new orders and refills — double-checked by our in-house auditors for exceptional reliability.
Testimonials
Our Results
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