Hey there, pharmacy owners! If you are managing a Long-Term Care, Community, or Retail pharmacy, you’re probably always on the lookout for ways to improve your bottom line and reduce those dreaded audits. Let me tell you about a game-changing strategy: Pre and Post Edits (PPE). That might sound a bit technical but stick with me—this stuff is pure gold for your business.
What Are Pre and Post Edits?
Before we dive in, let's get on the same page about what Pre and Post Edits are.
Pre Edits are checks that happen before a submitted prescription claim reaches the 3rd party for reimbursement. Think of them as a safety net that catches errors, ensuring everything is accurate and compliant before it goes out the door.
Post Edits, on the other hand, occur after the claim has been submitted and looks at the information provided in 3rd party response. These are like a second line of defense, double-checking everything to ensure that your claims are paid as expected and identifying any 3rd party messages that you need to be aware of.
Be aware that while there are several providers who offer Pre and Post Edits, not all solutions are equal and not all will produce the same benefits for your pharmacy. QRx Solutions offers one of the most robust Pre and Post Edit programs available.
How Do Pre and Post Edits Increase Revenue?
1. Fewer Rejected Claims: When your claims are accurate the first time around, they are less likely to be rejected. Rejections mean delayed payments and more work for your team. By catching errors up front, you speed up the reimbursement process, which means more money flowing into your pharmacy faster.
2. Maximized Reimbursements: Pre and Post Edits help ensure that you are billing for everything your pharmacy is entitled to. They make sure you aren’t undercharging for services or missing out on billing opportunities. Every dollar counts, right?
3. Enhanced Efficiency: With fewer errors and rejections, your staff can focus on more valuable tasks instead of constantly fixing mistakes. This boosts overall efficiency, allowing you to serve more customers and potentially expand your services.
Cutting Down on Audits
Audits can be a nightmare—stressful, time-consuming, and costly. Here is how Pre and Post Edits can help you avoid them:
1. Ensuring Compliance: These edits help ensure that your claims meet all regulatory requirements. They catch common compliance issues that could trigger an audit, giving you peace of mind.
2. Accurate Documentation: Proper documentation is key to surviving an audit unscathed. Pre and Post Edits help ensure that all your prescription records are accurate and appropriately documented, reducing the risk of audit findings.
3. Reducing Fraud Risk: By catching and correcting errors, Pre and Post Edits also help prevent fraudulent claims. This is crucial because even unintentional mistakes can sometimes be flagged as fraud, leading to hefty fines and serious legal issues.
Real-World Success Stories
Let’s look at a couple of success stories: Long Term Care Pharmacy: A long term care pharmacy implemented QRx’s Pre and Post Edit solution and saw a 20% reduction in claim rejections within the first six months. This led to quicker payments and an annual revenue increase of over $100,000.
Community Pharmacy: A community pharmacy that was frequently audited due to minor errors managed to cut their audit frequency by half after adopting the QRx PPE solution. They saved thousands in audit-related expenses and were able to reinvest that money into expanding their patient services.
How to Get Started
Ready to take the plunge? Here’s a simple plan to get you started with QRx Solutions:
1. Assess Your Current Process: Take a look at your current claims process and identify where errors are most likely to occur. Schedule a demonstration with QRx Solutions to see how our PPE solution can improve your bottom line and reduce your rejections.
2. Choose the Right Tools: QRx Solutions is the best in class and helps maximize reimbursement, improve productivity, shorten collections windows, reduce resubmissions, and increase profits. Integration at the point of sale optimizes workflow resulting in enhanced productivity and faster collections.
3. Train Your Team: QRx has a seamless implementation and is known for its great comprehensive customer service. We will train your staff via either live webinar or provide training videos that allow your staff to review as their schedule allows. We understand time is precious and we are able to accommodate as your pharmacy needs.
4. Monitor and Adjust: The QRx team monitors claims once the implementation is complete and routinely reviews pharmacy claim submission and response adjudication data to actively look for additional areas of opportunity or emerging trends.
Your Next Step
If you are serious about boosting your revenue and slashing audits, it’s time to consider implementing QRx’s Pre and Post Edits in your pharmacy. The benefits are clear: fewer rejected claims, maximized reimbursements, improved efficiency, and reduced audit risk.
Why not give it a shot? Your bottom line will thank you.
Feel free to reach out to Angie Smith at (678) 400-0738 if you need any advice on getting started. We’re here to help you make your pharmacy the best it can be. Happy dispensing!
