Driving revenue streams with pharmacy technology
As the nation's healthcare system continues to evolve, community pharmacies are searching for new ways to attract patients and create new revenue opportunities. Because this has mostly meant expanding the services they offer, streamlining payment and reimbursement processes has taken on added importance.
"The average independent pharmacy has $180,000 of receivables at risk annually," said Lari Harding, VP of product marketing at Inmar, which offers a range of solutions to help retail pharmacies cope with the growing complexities of the claims and payment reconciliation process.
"A good reconciliation solution gathers 835 files and provides basic reporting so your staff can pursue collections," Harding said. "A best-in-class solution finds missing data, helps address slow payers, identifies collectible funds and even chases down unpaid claims so your pharmacy can recoup as much as possible."
Payment and reconciliation suppliers say the greatest challenges facing pharmacies today revolve around direct and indirect remuneration, or DIR, fees. Because pharmacies often do not have detailed insight into drug pricing and post-adjudication service fees, discount card fees and these DIR fees, they often are challenged to manage their revenue line.
"These fees are often taken back as lump sums in the 835 payment files, and claim-level detail is not provided," Harding said. "This makes it challenging to assess if the fees are fair and to use the data to improve your business."
Inmar is among a handful of tech companies that have joined forces to test ways to create more standards for reporting DIR fees.
"PBMs are under scrutiny to enable transparency to both the payers and the providers," Harding said. "Both new technology tools and new business practices will evolve to help better support true cost transparency. Consumers are bearing more of the costs and will demand to understand them. Payers will continue to evolve toward a value-based business model, which will also require the ability to see the full picture of costs and outcomes."
The quest to bring more transparency to DIR fees is just one of the changes afoot in the payment and reconciliation arena.
"We've seen payment reform on the prescriber side, but it was accomplished by requiring updated certified technology, allowing all providers active in the care of a patient to exchange and share data," said QS/1 retail interface analyst Crystal Ratliff. "The pharmacy side will not be different.”
"The vast majority of patients have multiple disease states and are not compliant with their medications," she said. "Decreased reimbursement for traditional dispensing services has created operational challenges for pharmacies, further emphasizing the need for payment-based enhanced services.”
QS/1 is among a handful of technology suppliers that are developing new methods that are not only making it easier for pharmacies to get paid for their efforts, but also are ensuring the security of the consumer credit card data they collect from the millions of transactions they process every day.
Last month, for example, the company announced that its point-of-sale systems now meet the guidelines of the Qualified Integrators and Resellers program.
“Research has proven that installations not done correctly can open the door for networks to be compromised,” QS/1 manager of systems development Chris Lewis said when the certification by the Payment Card Industry Data Security Standard was announced.
Those in the payment sector said that making pharmacies' systems more secure, and integrating them into the broader healthcare network, is crucial for the industry to enhance its standing with patients and payers.
"Technology, integration and interfaces are the way of the future; and not all interfaces or integrations are created equally," QS/1's Ratliff said. "Healthcare software systems must be prepared to communicate and share data with other systems across the patient care continuum."