Navigating Pharmacy Services: Addressing Your Top Concerns

Addressing Medical Provider Questions on In Office Dispensing and Mail Order Pharmacy Questions

As a medical provider, you're focused on delivering the best patient care. That's why we understand the importance of efficient and effective pharmacy services, whether it's through mail order or in-office dispensing. We've compiled some of the most common questions and concerns we hear from providers, and we're here to provide clear, concise answers.

Billing and Financial Considerations for Pharmacy Services

• "I don't want to chance writing higher reimbursing meds. Why bill higher WC meds if they may affect my referrals?"

  • Our billing adheres strictly to state fee schedules, just like any reputable management company. It's crucial to understand that case managers and adjusters serve distinct roles; adjusters are the ones who review bills. If necessary, we can tailor a lower reimbursing formulary to meet your specific needs.

• "Attorneys dictate where the Rx goes - how can we overcome this obstacle?"

  • Legally, patients have the "Choice of Pharmacy." Attorneys cannot legally mandate where a prescription is filled. Only the patient can make this decision. As their physician, you can offer recommendations for optimal patient care.

• "Why send to another pharmacy and make $0 vs using us?"

  • Our platform integrates seamlessly with your EMR (with read-only access), enabling standard e-prescribing and minimizing pharmacy call-backs. This prioritizes patient care and creates an ancillary revenue stream for your practice.

• "We already have in-office dispensing set up with another company. What makes your platform better?"

  • Our collection rate is a minimum of 20% higher than our competitors, with a 90%+ collection rate for Workers' Compensation. We handle any denied claims diligently and don't give up easily, ensuring you don't lose revenue. We also offer hybrid business models and do not outsource any of our services. When comparing management fees, remember that a smaller percentage of a smaller collection is still a small number.

• "How does a Sub MSO and Claims Purchase work? How does a hybrid of both payment models work?"

  • Clear Fee Structure Options Include:

    • MSO (Set Fee) - Through the Sub-MSO contractual framework, AdvancedRx establishes a set fee for services which resets every 6 (six) months (based on past activity). A gross margin collected during that six month period, is then paid monthly.

    • Claims Purchase/Factoring Service - There is a Claims Purchase fee per claim, Less COGS - Medication Costs & Shipping, Advanced Rx Management Fee.

    • Get a % of Net Collections on a Hybrid of both. *Average Blended Net of COGS. Collections may fluctuate slightly depending on the mix of Claims Purchase versus MSO Models. Contact us to discuss the average you should expect.

Efficiency and Workflow

• "Why should I do this extra work for dispensing in-office? Will this have impact on workflow and efficiency at my office? We can’t add one more process for our staff. We don’t have the staff to handle extra work. We tried in-office dispensing before with no success."

  • If workflow is a concern, we recommend starting with mail order. You can simply change the pharmacy to Advanced Rx Pharmacy 060 - TN when e-prescribing. We can transition to in-office dispensing once your staff is comfortable. Our services include medication inventory management, reducing staff burden. Read-only EMR access also streamlines the process.

• "I already have an in-office dispensing setup, staff has no time. What makes your platform better?"

  • Our 90%+ collection rate on workers comp claims, internal handling of all processes, and e-prescribing capabilities minimize staff workload and maximize revenue potential.

• "I already dispense in-office. How can mail order benefit my practice and patients? Or I'm concerned mail order will compete with my in-office dispensing. How do you address that?"

  • Our mail order service complements your in-office dispensing by:

    • Expanding medication access, including less common or high-cost medications.

    • Reducing staff burden through streamlined prescription processing.

    • Generating continued revenue through our MSO and Claims Purchase models.

    • Enhancing patient convenience with home delivery.

    • Improving patient adherence through automated refills and direct delivery.

Medication Delivery and Tracking

• "What if Patients don't get meds in a timely manner, then stop using mail order? What if my Patient can’t wait 3 days for medication?"

  • Read-only access enables same-day processing for orders placed before 1:30 PM CST. Mail order delivery typically takes 2-3 days, and we offer expedited shipping for priority patients.

• "Mail order: How does a physician know prescriptions are being paid/filled/sent?"

  • Physicians can track orders through our portal, which is updated daily.

Expired Medications and Prior Authorizations

• "What do clinics do with expired meds and prior auth?"

  • We handle expired medications; you can ship them back to the pharmacy. Our In-office billing process bypasses prior authorizations, which are the provider's responsibility. Proper inventory management handled by our team can prevent expired medication.

EMR Access

• "Read only Access to MY EMR? I don't trust giving this access!"

  • Read only access drastically decreases workflow interruption, ensures top collection and capture rates, and optimizes patient care. E-prescribing becomes seamless, and refills are handled automatically. We are fully HIPAA compliant.

Legality

• "How is this all legal?"

  • We've invested in Letters of Opinion from top healthcare attorneys specific by state. Our models adhere to all applicable state pharmacy laws, MSO guidelines, and e-prescribing regulations. We prioritize fair market value, written agreements, and clear separation of functions.

  • Key Considerations for Compliance:

    • Fair Market Value: All financial arrangements should be based on fair market value.

    • Written Agreements: Clear and comprehensive written agreements are essential.

    • Separation of Functions: Clinical and administrative functions should be clearly separated.

    • Compliance Programs: Implementing robust compliance programs can help mitigate legal risks.

    • Claims Purchasing: When claims are purchased, it is vital that the transaction is done at fair market value. Also that all involved parties are acting within the boundries of all applicable laws, and regulations.

    • Pharmacy Consulting: Pharmacy consulting must be provided in a manner that does not create conflicts of interest or induce inappropriate referrals.

We hope this comprehensive overview addresses your concerns. We're committed to providing efficient, compliant, and revenue-generating pharmacy services for your practice and patients. Contact us to discuss the specifics based on your state regulations.