In the United States, there are over 26,500 nursing homes. These long-term care (LTC) facilities serve about 1.4 million residents, each of which has its own diagnoses, treatment plans, and prescriptions.
LTC pharmacy billing can become pretty complex, and not knowing how to effectively deal with these complexities can cost your organization time and money. Such issues may include navigating billing models, payer requirements, and complicated Medicare guidelines.
Using the right strategy and technology is the key to properly managing this healthcare billing space. But first, let’s take a look at what long-term care pharmacies actually are.
Long-term care is any service that includes medical and non-medical care, provided to those who are unable to perform basic activities. These activities can include things such as dressing and bathing. There are a wide variety of support services that fall under the LTC category.
Those that can benefit from LTC services include:
* Patients with complex medical needs. Those patients who require 24-hour care or monitoring to maintain wellness.
* Patients recovering from serious medical events. This includes heart attack, stroke, or cardiac surgeries.
* Patients recovering from injuries/procedures.
* Patients who live with either temporary or long-term conditions that inhibit mobility.
* Patients who have physical impairments. These interfere with basic activities such as bathing, dressing, or using the toilet.
* Patients who need assistance with managing household tasks. Such as food preparation, cleaning, paying bills, and managing medications.
* Patients with Alzheimer’s disease or other cognitive issues.
The financing of LTC services and facilities comes from a variety of public and private sources. State Medicaid and Medicare Part D plans make up the primary payers. Other payers include contracts with nursing homes for patients covered under Medicare Part A and private insurers.
An LTC pharmacy provides specialized medication services and management for long-term care patients. Different from retail pharmacies, LTC pharmacies face a very specific set of billing challenges and intricacies that can affect the efficiency of their operation.
These services are crucial for ensuring the accuracy and efficiency of medication administration to facility residents.
Services can include:
* Daily delivery of medications in secure medication carts.
* Unit-dose packaging.
* Medication administration records (MARs).
* Medication synchronization.
* Prevent the diversion of controlled substances stored in the facility.
The LTC pharmacy ensures that medications get dispensed via medication carts, sectioned into separate compartments for each resident.
Each cart contains tools to assist in:
* Medication administration.
* Medication storage.
* Providing security of medications.
* Documentation of medication received, taken, refill requests, and discontinuations.
LTC pharmacies aim to streamline the medication management process with the use of these carts. Improving accuracy and enhancing patient safety while keeping data orderly and organized. These pharmacies also provide facilities with medication emergency starter kits. Facilities use these kits to meet the immediate needs of patients in accordance with their prescriber’s order.
Please note that LTC facilities do not usually own these pharmacies, but work with them through a contracted business relationship. LTC pharmacies are likely to hold contracts with a variety of different residential facilities.
As an LTC pharmacy, your efficiency and workflow are crucial. LTC billing can be complex in nature. However, with the right software, setup, and support, those complexities don’t have to negatively impact your bottom line.
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