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Cost of Claims Processing
Started by pharmalt82
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So, if a ptn asks if drug X, an alternative to an expensive drug that he is currently on, is covered by his insurance and what the cost would be and I'm at WAGS, putting through a dummy claim would be against my monetary interest and the best answer would be "go call your insurance company"?
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A hospital I rotated at routinely sent test-claims to determine which anticoagulant was covered under the patient's insurance.
How is it illegal if it is being deleted out reversed after?
Haha this comes up every now and then. I have never come across anything that leads me to believe it is illegal.
But, yeah I pretty much tell people to call their insurance. They can give them way more info than you can.
Biggest time this is an issue is when somebody shows up with discount cards, and asks you to bill them all and find out which is cheapest. Not only is there a cost for the claim transmission, but for the reversal as well. The cost depends on your software vendor and the 3rd party. While doing a management rotation, I was in a meeting discussing various software hosting solutions, and the prices ranged from 10-25 cents, generally.
Big chains probably have a better contract worked out, and having your own software rather than using a vendor's software should save money as well. I have never seen these figures show up on any P/E reports at the store level, in any of the places I've been.
Like Owle said, calling the insurance is the best option as they can give you not only the copay, but what tier, what a lower tier alternative may be, does it need prior auth, etc. And the patient can call themselves.
Big chains probably have a better contract worked out, and having your own software rather than using a vendor's software should save money as well. I have never seen these figures show up on any P/E reports at the store level, in any of the places I've been.
Like Owle said, calling the insurance is the best option as they can give you not only the copay, but what tier, what a lower tier alternative may be, does it need prior auth, etc. And the patient can call themselves.
I hate to say this, but its true. I am not a representative of your insurance company, you asking me, through a drive-thru, as to what the alternatives to a drug are and whether they are covered or not is just you being a lazy idiot and I do give the expedient answer: "Call the number on the back of your insurance card, they will tell you, we don't have access to that information."
At a private, I would bother to go to fingertipformulary.com to help someone out if I had the time.
Oh God, pharmacists making up laws again.
Makes you wonder how much it cost to process triplicate universal claim forms back in the day
I wonder if people are thinking of the laws against billing for nonexistent prescriptions (i.e., fraud)? I don't think you can apply anti-fraud laws to claims that are reversed but I can see how some people might read the law that way.
Yes. I would figure the discount pricing for big chain to be about 5-6 cents a transaction.
Wonder what the graph looks like when you compare employee shrink vs. "unnecessary" processing costs.
If anything, it's a time sink. Tying up your technician for 5 minutes typing and running additional claims you're not paying for = 0.083 hrs x $10/hr = $.83, not including bene's and whatnot. The $.05 transaction cost is like 6% of that. Even worse if your tech is seasoned and making more than $10hr.
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