Claims reconciliation is a necessity for small, independent pharmacies. As a pharmacy owner, you simply can’t afford to not reconcile your claims. Unlike large, big-box stores with corporate support, independent pharmacies rely on third-party reimbursements to keep the lights on and ensure their business thrives. Reconciling each claim accurately and efficiently is crucial for improving your profitability, maintaining a competitive edge, and running a healthy business.
However, for smaller pharmacists the struggle is real. Claims reconciliation is a time-consuming and complex process that most independent pharmacists don’t have time (or manpower) to manage without help—not to mention that most would rather spend their time building relationships with patients in the community than staring at spreadsheets and crunching numbers.
Learn about the future of pharmacy claims reconciliation and the different steps you can take to improve your processes and continue helping customers.
How Claims Reconciliation Differs in Independent Pharmacies
Claims reconciliation differs (and needs to differ) in smaller, independent pharmacies in order to keep patients happy and influence positive relationships in their communities. Along with facing declining reimbursements, independent pharmacies are competing with large chain stores and fighting to stay open, which is especially important in rural areas that are often underserved.
“In many ways, the market remains hungry for the kind of services independent community pharmacies provide that big box stores are not equipped for,” said B. Douglas Hoey, chief executive officer of the National Community Pharmacist’s Association (NCPA). “Community pharmacists don’t have to wade through corporate red tape or run things by a distant corporate office. They can make decisions that work for them and their patients.”
In many cases, rural pharmacists play an essential role in their communities and often serve as the first line of defense for patients without access to a primary care provider. But the reality is, small, independent pharmacies now need to work harder than ever before to stay relevant to their patients and communities. Effective, accurate claims reconciliation can be a stepping stone to getting there.
With that said, many independent pharmacists still reconcile claims manually, which is not only tedious and error-prone but also takes time away from patients. (In all fairness, you didn’t go to pharmacy school with the intention of being an accountant or accounts receivables specialist, right?)
In a survey on the biggest obstacles they face, 93 percent of independent pharmacists cited problems with fair reimbursement as barriers to running a successful business. The same survey revealed that 65 percent of independent pharmacists see reimbursement as a barrier to providing good patient care.
Here’s how Jeff Sherr, president of Apple Discount Drugs in Maryland, explained the current landscape for independent pharmacies like his: “The tough part is you can generate revenues, but you’ve got to make a profit. We’re not talking about hitting home runs. We just want to be able to show a profit so we can continue to provide these services for people.”
Fortunately, advances in pharmacy technology are now allowing pharmacy owners to automate and improve claims reconciliation processes. Like so many other areas of the business, automation technology helps pharmacists efficiently manage the intricacies and complexities associated with claims reconciliation.
Game-Changing Claims Reconciliation with Advanced Pharmacy Tech
Investing in a modern claims reconciliation solution can be a serious game-changer for independent pharmacists looking to increase their profitability and improve the health of their business. Claims reconciliation technology helps independent pharmacists by:
- Taking complexities out of managing third-party reimbursements
- Identifying missing and partially paid prescription claims
- Providing full transparency into financial trends and fees
- Identifying direct and indirect reimbursement (DIR) fees
- Working more efficiently to spend more time with patients
- Eliminating reimbursement errors to ensure full payments
- Pinpointing the third parties that are slowest at reimbursement
- Reconciling all pharmacy and medical claims in one place
For many independent pharmacies, the benefits of using claims reconciliation solutions speak for themselves. After using claims reconciliation software to manage third-party payments, White Cross Pharmacy in Orange County, California discovered $100,000 in missing reimbursements—a significant amount of money, especially for a small business owner! “I did not even know the money was missing,” said Dr. Sameer Rakholia, chief operating officer and pharmacist in charge at White Cross Pharmacy.
Enter ECONCILE: Taking the Headache Out of Claims Reconciliation
With the right solution, you can perform claims reconciliation the way you’ve always intended to: accurately, efficiently, and effectively. This way, you can continue building positive relationships with patients and members of your community, minus the constant fear of shutting your doors.
FDS’s ECONCILE solution enables independent pharmacists to develop comprehensive, cost-effective claims reconciliation processes. With cloud-based receivables management powered by robust reporting and end-to-end client support, ECONCILE offers a way to easily manage third-party receivables and monitor payments for prescription claims, without breaking the bank or taking time away from your patients.
We know what you’re thinking: the last thing you want or need is another system to manage. However, ECONCILE is a pharmacy technology add-on, as opposed to clunky, locally-managed software. In other words, you won’t need to install or maintain additional software that promises to help but ultimately slows down your pharmacy workflows. For pharmacists looking to outsource their entire claims reconciliation process, FDS also provides comprehensive services to manage third-party receivables.
Looking for a way to improve your claims reconciliation processes to spend more time with patients and drive long-term sustainability for your business? Schedule a demo to see firsthand how ECONCILE can help you take your pharmacy business (and patient care) to the next level.
