Blog

Why Are More LTC Pharmacies Turning to Outsourcing for Billing?

When running a long-term care (LTC) pharmacy, billing isn’t just about ensuring accuracy and compliance—it’s also a key factor in maintaining cash flow and profitability. Many LTC pharmacy operators opt for in-house billing, believing it provides better control. However, the reality is that managing billing internally comes with hidden costs that can impact your bottom line and operational efficiency. This is where outsourcing, with companies like Staffingly, Inc., offers a compelling alternative by saving time, reducing expenses, and enhancing accuracy.

Let’s break this down to uncover the hidden costs of in-house billing and how outsourcing might be the smarter, cost-effective choice for LTC pharmacies.

Key Takeaways

• In-house LTC pharmacy billing involves hidden costs such as staffing, training, compliance risks, and technology expenses.
• Outsourcing offers scalability, cost savings, and access to skilled professionals without the burden of ongoing investments.
• Partnering with a provider like Staffingly, Inc. can save up to 70% of billing costs while enhancing compliance and turnaround times.

The Hidden Costs of In-House LTC Pharmacy Billing

While managing billing internally seems straightforward, it involves numerous hidden costs beyond payroll and software. Let’s look at these costs:

Staffing and Training Costs

• Staff Wages: Hiring experienced billing staff is costly. Experienced billing professionals often demand competitive wages, benefits, and potential overtime for handling billing peaks.
• Training: As healthcare regulations evolve, continuous training is essential to stay compliant. This can quickly become expensive and time-consuming, particularly for small or medium-sized LTC pharmacies.
• Turnover: High employee turnover rates in the billing department lead to recruitment and onboarding expenses, along with productivity losses during transitions.

Compliance Risks and Errors

• Regulatory Complexity: LTC pharmacies operate under a web of regulations. Errors or delays in billing Medicare, Medicaid, or private insurers can result in claim denials, penalties, or audits.
• Audit Readiness: Keeping your billing practices audit-ready demands rigorous internal processes. Failure to do so can incur fines or even reputational damage.
• Cost of Denials: A claim denial can cost a pharmacy an average of $118 to rework and resubmit. Frequent denials may lead to lost revenue, delayed cash flow, and additional staff hours.

Technology and Infrastructure Investments

• Billing Software: Maintaining a robust billing system requires significant upfront and ongoing investments. Regular upgrades, licensing fees, and system maintenance are additional burdens.
• IT Support: In-house systems demand IT infrastructure and support, which may not be cost-effective for smaller LTC pharmacies.
• Cybersecurity: Ensuring that patient data remains secure adds another layer of expenses, from data encryption to compliance monitoring software.

Operational Inefficiencies

• Time Management: Billing is time-intensive, pulling focus away from other critical pharmacy operations.
• Delayed Cash Flow: Internal delays in billing processes can create cash flow bottlenecks, impacting financial health and growth potential.

The Advantages of Outsourcing LTC Pharmacy Billing

Outsourcing eliminates many of these hidden costs and provides added benefits:

Significant Cost Savings

Outsourcing with a provider like Staffingly, Inc. can save up to 70% on billing costs. Without the need to hire, train, or manage in-house teams, you eliminate payroll, benefits, and turnover-related expenses.

Access to Expertise

Outsourced billing teams specialize in navigating the complexities of LTC pharmacy billing, including compliance and reimbursement trends. They often have dedicated teams monitoring regulation changes, ensuring claims are accurate and timely.

Enhanced Technology and Tools

Providers like Staffingly, Inc. use cutting-edge billing software and tools without requiring pharmacies to make large capital investments. This ensures efficiency and security while remaining compliant with HIPAA and other regulations.

Focus on Core Operations

By outsourcing billing, LTC pharmacies can focus on improving patient care, streamlining inventory management, or growing their client base instead of being bogged down by billing-related tasks.

Real-World Example: How Outsourcing Transformed an LTC Pharmacy

An LTC pharmacy, “ABC Healthcare Corp.,” struggled with high denial rates and cash flow delays due to in-house billing inefficiencies. After partnering with Staffingly, Inc., they:

• Reduced denial rates by 45% within the first quarter.
• Lowered billing costs by 60%, eliminating turnover and training expenses.
• Improved cash flow with faster claim submissions and reimbursements.

What Did We Learn?

In-house LTC pharmacy billing may appear manageable, but it often carries hidden costs that affect long-term profitability and efficiency. Outsourcing eliminates these challenges by providing cost savings, access to expertise, and improved compliance. For LTC pharmacies looking to streamline their operations while staying ahead of industry regulations, outsourcing with a trusted partner like Staffingly, Inc. is the ideal solution.

FAQs

1. How does outsourcing billing reduce costs for LTC pharmacies?

Outsourcing eliminates the need for payroll, benefits, training, and turnover expenses associated with in-house billing teams. Providers like Staffingly, Inc. also offer access to advanced tools and skilled professionals, reducing claim errors and denial rates.

2. Is outsourcing billing secure and HIPAA-compliant?

Absolutely! Reputable outsourcing partners, including Staffingly, Inc., prioritize data security, employing encrypted systems and maintaining HIPAA compliance to protect sensitive information.

3. Will I lose control of the billing process by outsourcing?

No. Outsourcing partners provide detailed reporting, transparent communication, and customizable workflows, allowing you to retain full visibility and control over the process.

4. Can small LTC pharmacies benefit from outsourcing?

Yes! Outsourcing is scalable, making it an excellent option for small LTC pharmacies looking to reduce overhead while ensuring billing accuracy and compliance.

Disclaimer

The information in our posts is meant to inform and educate both healthcare providers and readers seeking a better understanding of the prior authorization process. However, it is not a substitute for professional advice. Insurance requirements, policies, and approval processes can vary widely and change over time. For accurate guidance, healthcare providers should consult directly with insurers or use professional resources, while patients should reach out to their insurance providers or healthcare professionals for advice specific to their situation.

This content does not establish any patient-caregiver or client-service relationship. Staffingly, Inc. assumes no liability for actions taken based on information provided in these posts.

For tailored support and professional services,

please contact Staffingly, Inc. at (800) 489-5877

Email : support@staffingly.com

AUTHOR: William Harper is an experienced author with a strong background in healthcare, specializing in LTC pharmacy billing. With years of experience in healthcare writing, William brings a wealth of knowledge in LTC pharmacy billing, focusing on simplifying intricate processes for his audience.

Reference

https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/LTCGuidance.pdf?utm_source=chatgpt.com