Intro
The prescription reimbursement landscape presents unique challenges for community retail pharmacies across the country. Pharmacies are finding it harder to maintain adequate margins and sustain rising DIR clawback payments. With an imposing “DIR cliff” on the horizon, many pharmacies are capitalizing on new revenue streams from clinical services. In this case study, we examine how one pharmacy in Texas earned over $19,000 in their first month billing clinical services to the medical benefit using billing automation technology with DocStation.
The Need
A prominent pharmacy in Austin, Texas has been administering vaccines to patients for years. The pharmacy has been earning revenue on the service by billing for the product and dispensing fee to the pharmacy benefit. However, the pharmacy was leaving money on the table by not billing the outpatient encounter associated with vaccine administration to the medical benefit.
Solution
DocStation bulk claim upload automation transforms a report of past vaccine & medication dispense events into unique medical claims for review and submission to the medical benefit. This enables pharmacies to back bill claims for encounters that occurred up to 12 months in the past based on timely filing windows specified by payers.
DocStation billing automation identifies billable events in real-time. This functionality has the unique ability to detect when medications often associated with a service component (e.g. vaccines, new prescriptions, opioids, antibiotics) are dispensed and queue up medical claims for review & submission by pharmacy staff at the time of service. Once submitted, DocStation follows each claim through the revenue cycle process, ensures accurate coding, and manages rejections/denials to achieve maximum reimbursement.
Outcome
DocStation worked with the Austin pharmacy to identify all vaccine encounters that occurred within timely filing window for back billing. During these encounters, pharmacy staff spent an average of 15 minutes with each patient and captured a record of each event in the dispensing system. A report was exported from the dispensing system and uploaded into the DocStation platform leveraging bulk claims upload automation. DocStation transformed the report into 1,489 unique medical claims that were reviewed & submitted to the medical benefit. The pharmacy earned $19,000 in net new revenue in their first month with DocStation with an additional $150,000 currently making its way through the revenue cycle.
The Austin pharmacy is now leveraging DocStation billing automation to queue up medical claims for all future vaccine administration, medication counseling and diabetes education encounters in workflow. Billing automation generates around 200 medical claim submissions and $10,000 in billings per month. The pharmacy is estimated to earn over $100,000 in net new revenue in their first year on the DocStation platform.
