Cardinal Health launches new Medicare Part B billing solution
Cardinal Health launched a Medicare Part B billing solution, which helps improve operational efficiency by consolidating Medicare Part B reconciliation into one platform, at Cardinal Health RBC 2018.
“We’re giving our customers a solution that allows them to bill and reconcile Part B claims within their existing reconciliation platform,” Amy Hughes, senior manager, Product and Solutions Marketing at Cardinal Health, told Drug Store News. “They can reconcile their Part B claims and all of their other pharmacy claims in one integrated portal. They don’t have to log into our [reconciliation] tool to look at all of their pharmacy claims and then spend additional time trying to look at and manage their Part B claims.”
Medicare Part B billing incorporates a broad swath of services and products that pharmacists provide, including immunizations, ostomy products, nebulizers, diabetic supplies and durable medical equipment.
In fact, the ability to adjudicate a Part B claim may help lay the groundwork for additional patient care services as provider status takes effect at the state level, Hughes added. “Right now, we’re laying the foundation with this Part B [solution],” she said. “It gives pharmacists a way to bill for claims that fall under a medical benefit. [Pharmacists] will eventually be able to bill for more services as pharmacists continue to practice at the top of their license, providing more clinical care.”
The new fee-based billing solution addresses a significant issue for independent pharmacists, Hughes said. “That’s a pain point for them today, having to [reconcile] in two different places and not having visibility to everything in one place,” she said.
The new program also represents a first-of-its-kind solution, Hughes added. “There are other solutions on the market that allow pharmacists to bill Part B. What differentiates us is we’ve pulled it into one platform,” she said. “From a reconciliation standpoint, we’re the first PSAO to do this. It’s something we’re really proud of.”
To date there has been a lot of positive feedback over the new solution, Hughes noted, including the ability to conduct an eligibility check prior to filing a claim and the overall visibility of claims that are associated with the tool, including what the pharmacists have reported and the status of each claim.
Click here to learn more about how this solution can help you bill, track and reconcile your Medicare Part B claims in real time.
Strength in numbers: Advocacy in focus at Cardinal Health RBC 2018
At the Cardinal Health RBC 2018 Opening Session in San Diego, pharmacy owners heard about the ways they can work together to bring change to the current reimbursement model.
Doug Hoey, president and CEO of the National Community Pharmacists Association, and Ritesh Shah, owner of Drug$mart Pharmacy in Keansburg, N.J., spoke to Steve Lawrence, Cardinal Health senior vice president of independent sales, about how independent pharmacies’ strength lies in their numbers when it comes to changing policy.
Hoey noted that progress has been made in bringing to light the reimbursement issues that community pharmacies have with pharmacy benefit managers. He highlighted recent stories from “60 Minutes” and The Wall Street Journal that shined a light on the issue and noted that even President Donald Trump has taken notice of PBMs.
“We can’t let up — we’re reinventing pharmacy and redefining how we get paid,” Hoey said, noting that NCPA members are bringing some of their legislators to tour their pharmacies and educate them about the reimbursement system.
This direct approach is one way that pharmacies can help effect change on an individual effort, and Shah highlighted ways that pharmacists can do so on a larger level.
Shah, who chairs the New Jersey Pharmacists Association Political Action Committee, said that lawmakers in his state, after listening to a coalition of community pharmacy groups, recently passed legislation focused on maximum allowable cost, or MAC, transparency, as well as legislation that subjects PBMs to state regulation and allows pharmacists to dispute with PBMs through the state, allowing them to enforce contracting standards.
Hoey noted that changing the current payment model, while a victory in itself, cannot be where pharmacy advocacy ends.
“It’s really important not only that we succeed in disrupting this current payment model, but that we also offer a solution that redefines how pharmacies get paid,” he said. “That solution is the Community Pharmacy Enhanced Services Network.”
CPESN USA is made up of local, largely state-based pharmacy networks that work together to negotiate contracts with payers as a clinically integrated network. Hoey noted that doing so helps elevate pharmacies to the same level as health plans and other healthcare providers in negotiation, which complements legislative efforts.
“When you put CPESN and the advocacy efforts together, that’s how we’re going to change how pharmacies are paid,” he said.
Shah said that pharmacies in New Jersey recently banded together to get a Jersey City independent pharmacy re-added to a network by telling legislators the new hurdles for Jersey City patients who might have to travel farther just to pick up their prescriptions.
“We fought hard, our numbers worked and we were able to get the pharmacy back into the contracts,” Shah said. “When you work together, united, it works. The numbers make an impact, but we have to stay focused and organized.”
Hoey noted that in addition to pharmacies being engaged, recent coverage and focus on pharmacy-related issues also is mobilizing patients, who he said can be a key voice to add to those of pharmacists.
“There’s no question staying organized and moving as one unified front makes for a very powerful force,” Lawrence said as he closed the panel. “Change just doesn’t happen — we have to get involved to cause change.”
AR you ready?
Augmented reality could break down patient care barriers
Even people who haven’t heard of augmented reality are probably familiar with its application in their daily lives. If they’ve played with Snapchat or Instagram filters, participated in the Pokémon GO craze or used digital tools from beauty companies to try before buying, they’ve used some form of AR. Fuse by Cardinal Health, the company’s innovation center, is exploring the role AR can play in patient care and showcased a prototype on the show floor at Cardinal Health RBC 2018.
“At Fuse by Cardinal Health, our explorations always start with the needs of the patient or user. Pharmacists are looking for tools that help them teach and coach patients about medication adherence,” Keith Gasper, principal engineer at Fuse by Cardinal Health, said.
According to an article on Essential Insights, an online publication sharing healthcare industry expertise from Cardinal Health, 51% of those 65 years and older take at least five prescription drugs regularly, and 63% of them say they forget their meds. Improving adherence should be a goal for all pharmacists, as adherence can lead to patients experiencing better outcomes, and nonadherence can result in revenue loss when prescriptions go unfilled.
“Augmented reality can be a powerful teaching tool for caregivers. Patients can understand complex topics related to their care through augmented reality aids that are visual, non-textual, three-dimensional and compelling,” Gasper continued.
At Cardinal Health RBC, Gasper and his team demonstrated how AR could be useful when taking medication. If patients had an AR-enabled tablet inside their medicine cabinet that could read medication labels, superimposing easy-to-understand 3-D graphics above the pill bottles with AR, it could help reinforce information that pharmacists want the patient to remember. This also could show auxiliary labels and medication schedule info, as well as warn against taking expired medication or highlight any potential interactions.
Gasper noted that this could be especially helpful in care transition situations when a patient gets home from a hospital visit overwhelmed with information and possible new treatment plans. These situations are the most fruitful for the nature of AR, he said. “Explaining how medications help your heart by using a visual, 3-D beating heart is more illustrative than using a drawing or pamphlet and is likely to be more memorable,” Gasper said.
On the show floor, the Fuse team was also interested in hearing from pharmacists about the potential uses they saw for AR in their pharmacies as a patient tool. Gasper said that they were particularly keen on its ability to bridge gaps in communication, possibly due to language barriers, in the pharmacy. Many suggested an in-store AR kiosk that would help patients find out more about products or the medication they’re taking.
With no requirement for specialized equipment, Gasper said, he sees a lot of potential in AR in a more straightforward way than other altered reality tools. “We are energized by AR because we can create powerful interactive experiences without the high barrier of entry that virtual reality or mixed reality require,” he said.
As technology continues to improve, Gasper said pharmacy tasks that can be manual or repetitive will become more commonly automated, leaving pharmacists better able to provide additional patient care services. As part of that, connectivity — integrating patient data from various sources and keeping it in one place — will be key for pharmacists and patients. Additionally, he said, home devices will be more connected. That leaves AR essentially at the intersection of connectivity and patient-facing tools.
“By taking familiar home devices and improving them through better connectivity and usability, we can help caregivers and families stay up-to-date on the status and health of their loved one,” Gasper said.