LTCRx Audit™ assures improved patient care, measurable results, and defined return on investment.
Long term care facility managers have a complex mandate: to deliver high quality patient care and sustain profitability while still maintaining compliance to Medicare Part D regulations. CSS's turnkey process offers solutions to ensure that the facility is:
• Being billed correctly from their pharmacy vendor.
• Deflecting charges for drugs that should be covered by other payers (i.e., Medicare PDPs).
• Receiving an easy-to-audit pharmacy bill in an Excel or database format.
How LTCRx works to eliminate incorrect billings:
CSS works with your staff to maintain current insurance status profile for your residents.
When your pharmacy sends each prescription claim through the CSS LTCRx Audit manager, our LTCRx program determines – within seconds -- who should pay for the prescription. If the facility is responsible, LTCRx will determine how much should be reimbursed, based on your vendor contract.
Prescriptions that should be paid by PDPs or other insurers are passed on to those entities immediately.
At the end of the month, you will receive an audit of all prescription activity in an easy-to-use Excel or database format. The audit tells you what your responsibility for prescription claims should be and the reasons you are paying for each item.
Discrepancies in your vendor pharmacy's bill can be easily identified by your CFO.