How A Pharmacy Cut Denial Rates by 30% with RCM

Denial rates are a common challenge for pharmacies across the country. For many, dealing with denied claims can be frustrating, time-consuming, and ultimately harmful to cash flow. In an industry where timely payments are crucial, denied claims can significantly impact a pharmacy’s bottom line. But what if there was a way to not only reduce denials but also improve overall collections and cash flow? This is the success story of how one of our customers, a multi-location pharmacy, achieved exactly that. With the help of advanced pharmacy RCM automation and pharmacy software to improve collections and cash flow, our esteemed client was able to reduce their denial rates by 30%, turning their financial struggles into a success.

The Challenge: Facing High Denial Rates

The pharmacy had been facing significant challenges with its revenue cycle management (RCM). They were experiencing high denial rates across multiple pharmacy locations, which led to delays in payment and disrupted their overall cash flow. Each denial meant time and resources spent addressing the issue, and the team was constantly battling against underpayments, coding errors, and slow collections. This not only slowed down cash flow but also created inefficiencies in their operations.

The pharmacy’s accounts receivable (AR) follow-up process was also in need of improvement. Denied claims were piling up, and without an automated solution, their staff spent valuable time manually checking on claims, following up with insurers, and correcting billing errors. Despite their best efforts, our client found it increasingly difficult to manage the rising number of claim rejections and ensure that all claims were processed correctly and efficiently.

With all of these hurdles, the pharmacy realized that they needed a more effective way to manage their RCM process, reduce billing errors, and speed up collections. They sought a solution that could automate claims processing, streamline AR follow-up, and enhance pharmacy cashflow management to improve overall financial performance.

The Solution: How Pharmacy RCM Automation Helped

After evaluating several options, the pharmacy chose our Analytics & Insights solution, which included pharmacy software to improve collections and cash flow. The decision was based on the software’s ability to report on at-risk claims, reduce errors, and improve the overall accuracy of claims submissions.

By implementing the Analytics & Insights dashboard, our client was able to simplify their billing process and ensure claims were coded correctly before submission. Automated checks were set in place to flag potential billing errors before claims were sent out, reducing the chances of denials due to coding mistakes. This significantly decreased the amount of time spent manually correcting claims.

In addition, our Analytics & Insights dashboard helped streamline the process of tracking unpaid claims and following up with insurers. Instead of relying on manual processes and spreadsheets, the pharmacy was able to use our software to automatically monitor the status of claims, ensuring that follow-ups were timely and effective. This proactive follow-up significantly improved collections and reduced the time it took to receive payment.

The Analytics & Insights dashboard also allowed our client to track cash flow in real time, giving them an up-to-date view of their financial health. This feature helped them identify areas of concern early on, such as unpaid claims or underpayments, and take immediate action to resolve them before they negatively impacted cash flow.

The implementation of the Analytics & Insights dashboard has completely transformed how we manage our revenue cycle. Not only have we reduced our denial rates by 30%, but we’ve also seen a huge improvement in collections and cash flow.

The Results: Hard Numbers and Customer Testimonial

The results were immediate and impressive. After implementing the Analytics & Insights dashboard, our client saw a 30% reduction in their denial rates within just six months. The reduction in denials had a direct impact on their cash flow. Claims were processed more accurately and quickly, allowing payments to be received faster and in full.

In addition to the reduction in denials, the pharmacy also experienced a notable improvement in collections. With the automated AR follow-up solution, claims that would have been overlooked or forgotten were now actively tracked, ensuring that no payment was missed. As a result, the pharmacy saw a 20% improvement in its collections within the same time period.

Overall, the pharmacy’s financial performance improved, with faster and more accurate claim processing, reduced denials, and enhanced cash flow. Here’s a direct quote from our client:

The implementation of medical billing RCM automation has completely transformed how we manage that revenue cycle. Not only have we reduced our denial rates by 30%, but we’ve also seen a huge improvement in collections and cash flow. DocStation has streamlined our processes and freed up valuable time for our team to focus on patient care. We couldn’t be happier with the results.

Final Thought

Our client’s success story is a testament to the power of pharmacy RCM automation and how the right pharmacy software to improve collections and cash flow can dramatically improve a pharmacy’s financial health. By reducing billing errors, automating claims processing, and streamlining AR follow-up, they were able to achieve significant improvements in their denial rates, collections, and overall cash flow.

If your pharmacy is facing similar challenges with denials, collections, and cash flow management, this story shows that the right pharmacy RCM automation tools can lead to tangible financial improvements. With the right solutions in place, pharmacies can streamline their operations, improve billing accuracy, and ultimately boost profitability.