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DUBLIN, Ohio — Cardinal Health recently enhanced its Reimbursement Consulting Services offering, which helps retail pharmacies ensure the accuracy of third-party reimbursement by identifying reimbursement errors and recommending strategies for correcting them, the wholesaler announced Tuesday.
According to the NCPA Digest, sponsored by Cardinal Health, independent pharmacies derive 92% of their revenue from prescription reimbursements. However, a number of factors can impact a retail pharmacy’s ability to ensure they receive the reimbursement they’re owed.
For example, a change in the average wholesale price of a specific medication can cause pharmacies to be reimbursed at an incorrect rate for that specific medication. Pharmacy technicians can enter incorrect medication quantities, causing the pharmacy to be reimbursed for a lower amount of medication than it dispensed. Pharmacies also often miss opportunities to recommend generic substitutions, which usually offer cost savings to patients and higher reimbursements for the pharmacy.
Cardinal Health’s Reimbursement Consulting Services addresses these challenges by reviewing data for all medications dispensed at a specific pharmacy, and flagging transactions that were inaccurately reimbursed. This service also provides access to bi-weekly phone consultations with a personal reimbursement advisor, who can help pharmacy owners understand which reimbursement errors can be corrected immediately through simply reversing and rebilling’ the claim, and which may require staff or other training to address over time.
Based on direct customer feedback, Cardinal Health recently introduced the following enhancements to its Reimbursement Consulting Services:
- Users can now access reimbursement reports via an intuitive online portal;
- Users can now access six new reports, three of which alert users of reimbursements that might cause specific types of audit risk. Other new reports include those that highlight a pharmacy’s highest profitability prescriptions or drug categories, and those that inform customers about changes in NDCs for specific medications;
- Users can also choose Excel spreadsheet or PDF as their report format. This functionality allows users to sort or filter data based on a number of criteria, ranging from size of reimbursement opportunity to reimbursement claims by specific payor; and
- Users who operate multiple stores can now also access reimbursement reports for each individual store, providing the opportunity to identify where additional, targeted training may be needed to ensure staff members understand how to avoid reimbursement errors.