Improving Pharmacy Claims Reimbursements – Outsource Now

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• Improving Pharmacy Claims Reimbursements
  Outsource Now

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Improving Pharmacy Claims Reimbursements
Outsource Now

• Pharmacies continue to scrutinize their income
  cycle in todays complex healthcare environment.
  As rising drug prices and declined reimbursements
  contribute to shrinking margins, pharmacy billing
  and coding is one place where industry leaders
  should look to make a positive impact on
  revenues.
• Today, if you review the challenges that a
  pharmacy faces in regards to revenue cycle
  management and ask industry insiders as to which
  one is their biggest challenge, the answer is
• Regulations and market challenges 30
• Payor practices 20
• Technology 50
• Well, its not a surprise, technology topped the
  list as it was also the main region that pharmacy
  leaders said would most benefit their
  organization.
• Health care facilities, especially pharmacies
  considering outsourcing their services should
  have a clear understanding of what they want to
  accomplish. Their consideration should include,
  an internal needs assessment, a cost scrutiny,
  and a careful review of possible workers. The
  organization should also examine the potential
  long-term consequences of outsourcing and also
  the short-term outcomes expected during an
  initial performance period.

Medical Billing Services in Oregon
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Improving Pharmacy Claims Reimbursements
Outsource Now

• Factors influencing outsourcing
• Various influences and market forces that may
  underwrite towards outsourcing being considered
  as a business option include the following
• Operational and Organizational
• Re-engineering and downsizing initiatives
• Alliance and integration of health systems and
  departments within health systems
• Exclusion of or reduction in the size of outdated
  departments
• Restructuring around patient-focused care
• Carrying out automated pharmacy systems and the
  need to reorganize medication distribution
  functions
• Staffing
• The scarcity of nurses and other health care
  professionals
• An absence of pharmacists with specific
  experience and capabilities
• Cost-Control and finance
• Controlled budgets
• Augmented operating costs
• Increased drug costs
• Increased importance of measuring performance in
  terms of staffing and costs instead of clinical
  outcomes

Medical Billing Services in Oregon
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Improving Pharmacy Claims Reimbursements
Outsource Now

• Quality
• Bigger expectations of and pressures from
  sanctioned pharmacies and consumer groups to
  improve the quality of patient care
• Governmental and Regulatory
• Increased numbers of persons dependent on
  federal, state, and local governments for health
  care
• Reduced capacity of federal, state, and local
  governments to finance health care
• Better government controls on reimbursement for
  health care
• Economical
• Increased competition among health care
  facilities
• Greater competition between suppliers of
  pharmaceutical products and related services
• Why Outsourcing?
• Pharmacies that conduct in-depth assessments may
  say that outsourcing either is or is not a good
  option for meeting their needs. Motives for their
  decision will vary according to a number of
  factors.
• Reasons to outsource pharmaceutical operation

Medical Billing Services in Oregon
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Improving Pharmacy Claims Reimbursements
Outsource Now

• Organizational
• Ease the alliance of pharmaceutical services in
  integrated health systems
• Resolve operational incompetence (by improving
  medication distribution systems, designing new
  pharmacy workspaces, decreasing medication
  dispensing and medical billing errors, and
  improving information systems)
• Permit the organization to acquire additional
  resources and skill to carry out other changes
  (restructuring of existing staff to
  pharmaceutical care roles in patient care areas)
• Arrange for educational programs for patients and
  their families and for health care staff
• Staffing
• Help the facility to staff hard-to-fill pharmacy
  positions
• Allow the facility to reach ideal staffing levels
  for achieving productivity targets
• Control the finances
• Regulate the cost of the organizations services
• Control or reduce employment costs (by shifting
  the cost of employees, benefits, and liabilities
  to a contractor)
• Empower the pharmacies to acquire an outsourced
  firm who will share the risks associated with
  operating the pharmaceutical services
• Evade the cost of purchasing and maintaining
  pharmacy equipment
• Avoid the cost of the physical makeover (by using
  the equipment of the outsourced firm to provide
  specific services for which remodeling would be
  required)

Medical Billing Services in Oregon
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Improving Pharmacy Claims Reimbursements
Outsource Now

• Quality
• Allow the pharmacies to maintain or expand the
  quality of patient care (by expanding clinical
  services and pharmaceutical care, creating new
  services, and finding specialized expertise in
  pharmaceutical care)
• Offer support for the medical and nursing staffs
  and expand the all-important physician, nursing
  and pharmacy collaboration.
• We are a group of medical billing experts who
  offer comprehensive billing and coding services
  to doctors, physicians hospitals. We provide A
  to Z billing and coding solutions. Medisys Data
  Solutions RCM solutions ensure that the providers
  recover every they are entitled to. Our vision
  for the providers is You Cure. We ecure
• You can reach out to us at info_at_medisysdata.com
  or 302-261-9187

Medical Billing Services in Oregon