At Neunetix, we understand the challenges specialty pharmacies face when it comes to Revenue Cycle Management (RCM). Denials pile up. Payments slow down. Margins shrink. The good news? There’s a proven path to success.
Here are the essential lessons you can apply today to boost your bottom line and streamline your operations.
Data Is Your Secret Weapon
Ogilvy famously said, “Big ideas come out of big data.” The same is true for RCM. If you’re not tracking your numbers, you’re flying blind.
Measure your Days in Accounts Receivable (AR). If it’s over 30, you have a problem.
Monitor your Clean Claims Rate. Anything below 95% means money is slipping through the cracks.
Track denials and dig into why they’re happening.
Action Step: Invest in analytics tools that let you see problems before they become disasters.
Fix Prior Authorizations at the Source
Specialty medications often come with sky-high price tags. A missed prior authorization can cost you thousands. The prior authorization process isn’t just a step—it’s the step.
Automate your workflows with tools like CoverMyMeds.
Standardize your team’s approach to payer requirements.
Action Step: Treat prior authorizations like a first impression. Get it right, or you’ll never see the money.
Stop Reacting to Denials—Prevent Them
Denials aren’t just frustrating—they’re expensive. We argue for a proactive approach.
Audit denial patterns monthly.
Train your team to submit claims right the first time.
Build a library of appeal templates for common denial reasons.
Action Step: Prevention costs less than appeals. Spend the time upfront to avoid chasing payments later.
Engage Patients Early and Often
Patients are paying more out of pocket than ever before. Patient engagement isn’t a “nice-to-have.” It’s a necessity.
Be upfront about costs. Transparency builds trust.
Offer payment plans. Patients are more likely to pay when it feels manageable.
Action Step: Make financial conversations part of the patient journey.
Train Your Team Like It’s Game Day
“Hire people who are better than you are.” – Ogilvy. Your team is your RCM engine.
Hold monthly training sessions on payer policies and compliance updates.
Equip your front desk staff to handle benefit verifications flawlessly.
Action Step: A well-trained team is your best defense against RCM chaos.
Leverage Technology to Scale
Manual processes belong in the past. Use technology to build an efficient, scalable RCM operation.
Integrate your billing, EHR, and RCM systems for seamless workflows.
Automate repetitive tasks like claim submissions and reminders.
Action Step: Invest in technology that works for you, not against you.
What’s Next?
RCM isn’t a set-it-and-forget-it process. It’s a dynamic system that demands constant attention and improvement. At Neunetix, we specialize in helping specialty pharmacies implement these best practices.
The results? Fewer denials. Faster payments. Happier patients.
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