Pharmacy Success Through COVID-19

By Jennifer Brink, Product Lead, Net-Rx and Sarah Dean, Team Lead, Net-Rx

The outbreak of the Coronavirus (COVID-19) has taken its toll on your patients, employees, families, and businesses. Healthcare professionals around the world continue to work tirelessly to support their communities. At Net-Rx™, a provider of pharmacy reimbursement solutions exclusively for pharmacies, we understand the complexity of working in a pharmacy, and that the everyday challenges now include the extra weight of worrying about your and your staff’s health, and how the current environment might impact your business.

During times like these, it can be easy for changes in claim volume, medication shortages, and coding errors to go unnoticed.    

Patients who receive care in nursing facilities are prime targets for coronavirus infection, which could cause major changes to both claim volume and profit margins in the facilities you serve. During this epidemic, we will see an increase in medication shortages causing limited allocation on multiple medications, escalated over-the-counter medication purchases, and 90-day fill requests. The combination of these will likely cause challenges in inventory management.

Get ahead of potential supply issues by fine-tuning your ordering practices. Frequently review your top moving medications, profit margins, and claim volume. You can also check the FDA medication shortage updates for up-to-date information on medication shortages. 

Metric-Rx® provides reports that outline utilization, claim aggregates, and profitability details for the facilities you serve, allowing you to easily review trending data across all your pharmacy locations. For example, the Ranked Drug report lists your highest-grossing and quickest moving medications (month-over-month trending data) and can be generated at your convenience.

Increases in the volume and complexity of prescriptions come with an increased risk of workflow disruptions such as claim rejections, overrides, and reimbursement challenges. 

Coding on your claims must be correct to receive accurate reimbursement. Some payers are currently allowing the use of Submission Clarification Code (SCC) 13 for “Payer-Recognized Emergency/Disaster Assistance Requested”. However, it is imperative that SCC 13 is only used when appropriate and per the payer’s specific directions. When you receive rejections, we suggest that you contact the payer directly to verify what coding they would like to see. 

The Claims Data Extract Tool in Metric-Rx provides reporting on over 55 claim elements, including Submission Clarification Codes and Diagnosis Codes.  

Here at Net-Rx, we have multiple tools available to help your business stay successful during trying times. To learn more about Net-Rx’s suite of solutions, visit https://www.net-rx.com/Products/Metric-Rx/. You may also contact us at, Sales@Net-Rx.com, or 1-866-336-3879.

MHA Coronavirus (COVID-19) Online Information Repository – http://mhaadvocate.com/coronavirus/

© 2020 Managed Health Care Associates, Inc. All rights reserved.