News

Keys to a successful 2013 flu season: Planning starts now

BY Mike Carmody

Spring is one of my favorite times of the year. It signals the end of many things and the start of others. Winter becomes spring. Flowers bloom. March Madness wraps up and The Masters’ tee off. Flu season transforms into flu season. Skiing and snowboarding melt into surfing and kayaking.

Wait, what? Flu season transforms into flu season?

Yes, it is true. The golden times of yesteryear when flu season ended in March and started again in September are no longer. Those circa 2008 days have gone the way of paper billing claims. In today’s world, April is the time to begin preparations for the wave of patients who will start visiting pharmacies as early as August to be immunized. On the heels of a severe flu season, past trends suggest the demand for flu shots this year will be tremendous. Since the H1N1 epidemic of 2009, we have seen a proliferation of pharmacies begin electronically billing vaccination claims to commercial payers as a medical benefit. Today it’s not uncommon to see a pharmacy touting “Most Insurances Accepted,” thereby attracting additional customers with convenience and the lack of copay fees. Commercial payers are now accustomed to contracting with pharmacies and have gone as far as educating their members that the pharmacy is a convenient location to receive vaccinations.

According to the CDC, less than half of children and adults in the U.S. received a vaccine by mid-November of 2012. Also, less than 20% of adults immunized received their vaccine at the pharmacy. These statistics demonstrate just how much opportunity there is for continued growth for our industry in the delivery of vaccines.

The key to having a successful flu season in 2013 begins with outreach to national and regional commercial payers now to kickoff the contracting process. By contracting with commercial payers, the claims billing solution enables your pharmacy to submit medical claims for vaccinations electronically to major commercial medical insurance payers in NCPDP format using the existing pharmacy management system. With this specialized processing solution, claims are subjected in real-time to eligibility and plan formulary based edits. Claims are then forwarded to the appropriate payers for adjudication and payments are delivered directly to the pharmacy. Connecting with the payers that offer coverage in your locality now, will allow plenty of time for implementation prior to the upcoming flu season. And when meeting with the commercial payer, it is helpful to compile your store inclusion list, billing tax identification numbers, billing national provider identifier numbers and pay-to-addresses in advance. This will allow for a clean enrollment, which is paramount to a successful vaccination program.

Once contracted, there are a number of resources you can utilize to guide you through the process including billing agents and dedicated customer service representatives with the commercial payer. Be sure to request a list of these key contacts for your staff as you begin implementation. By completing this work during April and May, you can greatly increase the likelihood of success in time for football season!


Mike Carmody
Director of DME/MedRx pharmacy services at Emdeon
Mike Carmody is the director of DME/MedRx pharmacy services at Emdeon. He is responsible for pharmacy solution product development and workflow efficiencies. Emdeon is a leading provider of revenue and payment cycle management and clinical information exchange solutions, connecting payers, providers and patients in the U.S. healthcare system.

keyboard_arrow_downCOMMENTS

Leave a Reply

No comments found

TRENDING STORIES

Polls

Which area of the industry do you think Amazon’s entry would shake up the most?
News

Stater Bros. appoints Peter Van Helden as president, COO

BY Alaric DeArment

SAN BERNARDINO, Calif. — A former executive of Supervalu has been tapped for a top position at Stater Bros. Markets, the supermarket chain said.

Stater Bros. announced that former Supervalu EVP retail operations Peter Van Helden had been hired as president and COO of the privately owned San Bernardino, Calif.-based chain, which operates 167 stores in San Bernardino and Riverside counties.

Van Helden began working as a courtesy clerk at Rosauers in Libby, Mont., in 1977, becoming a clerk at a Bozeman, Mont., Albertsons a year later, eventually rising through the ranks to become president and CEO of the supermarket chain’s California Food Division and joining Supervalu when it acquired Albertsons in 2006.

"Pete is a well-respected and long-time food industry executive," Stater Bros. chairman and CEO Jack Brown said. "I am confident that he will do an outstanding job as president and COO and will be valuable to the future growth of Stater Bros."

 

keyboard_arrow_downCOMMENTS

Leave a Reply

No comments found

TRENDING STORIES

Polls

Which area of the industry do you think Amazon’s entry would shake up the most?
News

Publix adds board member

BY Jason Owen

LAKELAND, Fla. — During its annual stockholders’ meeting today, Steve Knopik was elected to Publix Super Markets’ board of directors.

“We are pleased to have Steve join the Publix board,” said Publix chairman of the board Charlie Jenkins, Jr. “His strong retail and financial background and commitment to the community will make him a strong addition to our board.”

Steve’s 28-years of service at Beall’s started as director of finance in 1984 and led him to his current role as CEO. Prior to joining Beall’s, he started his career in 1977 with KPMG, a global accounting and auditing firm. He currently serves on the board advisory council for the Florida Retail Federation. He’s also a member of the Board of Directors of the Palmetto Youth Center and the Academy Prep Foundation, an organization that runs middle schools for economically disadvantaged children in St. Petersburg and Tampa, Fla.

Publix is privately owned and operated by its 157,500 employees, with 2012 sales of $27.5 billion. Currently Publix has 1,068 stores in Florida, Georgia, South Carolina, Alabama and Tennessee. The company has been named one of Fortune’s “100 Best Companies to Work For in America” for 16 consecutive years. In addition, Publix’s dedication to superior quality and customer service is recognized as tops in the grocery business, most recently by an American Customer Satisfaction Index survey.

keyboard_arrow_downCOMMENTS

Leave a Reply

R.MURRAY says:
Apr-17-2013 09:59 am

I purchase the majority of my food, etc products from Publix. The customer service on most levels is good however the main one I go to might just as well not have any staff or management as they are a friendly as a Mime, no interaction with customers. Perhaps this is by design?

TRENDING STORIES

Polls

Which area of the industry do you think Amazon’s entry would shake up the most?