Staffingly Video

How PBMs Impact LTC Pharmacy Billing-and How to Work with Them

What this video covers

This video breaks down how PBM contracts, DIR fees, audits, and rejection patterns affect long-term care pharmacy revenue, then lays out practical tactics for working within those constraints. It is for LTC pharmacy owners, billing managers, and consultants who need their teams to handle PBM requirements without losing margin or falling behind on resubmissions.

  • Know your contracts. Reimbursement terms, audit rights, and fee structures vary by PBM, and unread contract details cost pharmacies real money.
  • Track underwater claims. Compare reimbursement to drug acquisition cost on every claim so consistent losers get renegotiated, escalated, or dropped.
  • Audit-ready documentation. Complete dispensing records, signatures, and delivery confirmations decide whether a PBM audit ends in recoupment or dismissal.
  • Fast rejection response. PBM rejections resubmitted within days keep cash flowing; rejections left sitting in queues become permanent revenue losses.

PBM paperwork is exactly the kind of high-volume, detail-heavy work Staffingly dedicated pharmacy billing teams absorb. Trained specialists handle rejections, audit responses, and reconciliation with 24/7 coverage under a signed BAA, at flat weekly pricing that starts at $399 per specialist. Learn more about Staffingly’s LTC & Retail Pharmacy services.

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You pay for the resource. Everything else is included.

Your flat weekly rate covers one dedicated specialist. The management layer around them, backup coverage, quality reviews, training, escalation, reporting, and custom automation comes standard at no added cost. Here is what every Staffingly account includes.

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  • Who manages my account day to day?

    An account manager plus a customer success manager. Two named people own your account: the account manager runs daily operations and quality, the customer success manager handles onboarding and communication tools like ClickUp or Teams, so your team never chases an answer.

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    Backup coverage and same-week replacement. A cross-trained backup covers absences so your work never sits idle. If a specialist leaves or underperforms, we replace them the same week, trained on your workflows before the handoff.

  • How are holidays and leave handled?

    Planned in advance. Specialists receive approved US holidays and two weeks of paid leave per year. Coverage for those dates is arranged with you ahead of time, so continuity is planned, not improvised.

  • How do I know the work is getting done?

    Daily quality stand-up plus daily and weekly reports. Every account starts the day with a stand-up: what came in, what went out, what is stuck, and who is fixing it. You get a daily activity report and a weekly performance report, so nothing slips for a month before you hear about it.

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  • Will my rate change, and how do I add people?

    12-month price lock, easy scaling. Your rate is fixed for twelve months from your start date. Need more agents later? An email from your authorized representative is enough. Once confirmed in writing, new agents fall under your existing agreement. No new contract, no work order.

Dedicated specialists, never shared, working inside your EMR and payer portals under a signed BAA. One flat weekly price per operator covers all of the above.Book a Strategy Call