In my years in the home infusion industry, one of the most frequent mistakes made is the separation of the clinical / operations personnel and the billing / financial staff when it comes to accountability for accurate and profitable operations. The tension between servicing the patient and surviving financially doesn’t have to tear your business apart. Rather, the teamwork that results when the front end works with the back end will make a tremendous difference in the results of your business. Set up clinical reviews at the follow key “communication points”.
Confirmed Deliveries – a pharmacist can often catch many issues by looking at a delivery ticket much easier because they have a deeper understanding of the therapy and service being provided. Incorrect units, costs, missing nursing visits, inappropriate equipment and other errors can be corrected by reviewing a daily confirmed ticket report with detail before the reimbursement staff starts to work the ticket.
Unbilled “write-offs” – too many times I’ve seen billing staff write off services as non-billable due to incomplete documentation, missing authorizations and uncovered services. Making the general manager and director of pharmacy aware every time this happens will help a company reduce the occurrence of these events. Nobody likes “working for nothing”.
Payer denial review – try explaining to a pharmacist who spent time on the phone with the physician, time creating a care plan and compounding medication and took an after hours call from the patient that the therapy was not medically necessary. I’ve seen cases where pharmacists were able to make a significant difference in the outcome of a claim by providing information to the reimbursement staff or working with them to deal with difficult payer situations.
Financial reporting – at the end of the day (or month), we all want to know that we are doing well and our efforts are contributing to a healthy business. Share financial results with your staff as you would your investors. In fact, your employees are “investing” the best hours of their day in the business and there is nothing more motivating as success. Bringing the clinical and reimbursement staff together to evaluate results and develop strategy will pay off in the long run.