... continued from Cover
The post-edit occurs when the PBM returns the claim to the pharmacy, where it’s reviewed again for errors. □ Prepare for DIR Fee Apocalypse Every pharmacy owner knows that Direct and Indirect Remuneration (DIR) fees are evil. The big DIR fee change is just around the corner. Currently, your DIR fees are retroactive. This means you are paid more than you are supposed to be paid and the money is taken back later. Beginning on Jan. 1, DIR fees will be applied in real time when you submit a claim. This will cause your reimbursement to go down but will be more accurate. Many pharmacies have programmed estimated DIR fees into their PMS system to help manage them. When the DIR Fee Apocalypse hits on the first of the year, you will want to remove your programmed DIR estimates. □ Check Your Reverse and Rebill Report The same mediator who performs pre- and post-editing on your pharmacy’s claims can also provide you with a reverse and rebill report. This report shows when a drug’s price changes and if you submitted an outdated price, which led to a lower reimbursement than the current price. This report can point out these discrepancies so you can reverse the claim for the new price and get the higher reimbursement you deserve. We can’t keep up with every drug’s price change, but a reverse and rebill report can do it for you!
PBM optimization is a must, and optimizing your PMS is the first place to start. It strengthens your foundation and helps you get every penny you should be getting. Insufficient data leads to bad decision-making, which can cost you. Organize your data and let it lead you to the right path for your pharmacy!
If you have any questions, you can schedule a call with our coaches from your membership
dashboard. We’ll give you the one-on-one coaching you need to improve your PBM optimization.
Scan the QR code to check out PMS Checklist!
HAVE A LAUGH
561-379-7750 6
Made with FlippingBook Ebook Creator