Weighing the IT Options
As a pharmacy continues to offer DME, it will eventually need to start billing Medicare. At that point, it will likely require additional software to handle those claims. How should a pharmacy proceed?
Offering DME can be a real revenue boom to a pharmacy.
Many of those products are retail and can help drive
a sizable boost to the bottom line. But, at a certain
point, as a pharmacy offers DME items, it will need to
bill Medicare and maybe even commercial payers. This
is especially true when providing DME items related to
other conditions, such as pain management, sleep, or diabetes.
And that’s when the pharmacy discovers a real learning curve. The
DME billing process is very different from the way pharmacies do business.
Medicare Part B billing is more complex with greater documentation
requirements. In comparison, a retail pharmacy’s workflow cycle is
much shorter, from receipt of prescription to the claim adjudication and,
ultimately, dispensing the medication. In fact, pharmacies can immediately
see if a funding source will pay a claim and then dispense medication.
So, if you plan on pursuing DME enough that you need to automate
your DME claims processing, you need to start assessing the software
tools for doing that. There are two approaches: either finding an option
that can integrate with an existing software system or starting fresh.
Adding DME/HME billing software to an existing retail pharmacy involves
some challenges. To begin with, most DME software providers have built
their products around HME provider businesses and their workflows, and
then offer pharmacy software as an add-on module. That doesn’t mean
the pharmacy module is lower quality, but it does mean the DME software
might not be immediately compatible with what you are using now.
Start by seeing what’s available. If you are married to the system on
which your shop is running today, ask your software vendor if they have a
DME module you can add to it. If your vendor does, it might be worth the
upgrade, but unfortunately, most don’t. The next option is to ask a DME
software vendor if they will work with your pharmacy software providers
to create an interface with your legacy system.
To make your pharmacy and DME software work together, you would
need to add on a DME module or have an entirely different software program
that has an application program interface (API).
A key element in this scenario would be a shared patient database,
so both systems work from the same set of patient records. This will be
another systems integration challenge to hurdle.
IMPLEMENTING A NEW SYSTEM
If your existing software doesn’t support a DME module or provide an
API for communicating with a DME system, then you’re left with the other
option: swapping out your existing system for a new software system that
can support both pharmacy and DME workflows and billing.
Starting from scratch with a new system is a big decision, and where
you are in the life of your business and your existing software makes a
big difference. Ultimately, a combination or modular system is probably
your best choice because it will perform all the ME tasks while also carrying
out necessary pharmacy tasks, such as ensuring patient records are
updated correctly; allowing for the monitoring of medications; and keeping
an eye out for contra-indications.
Integrating pharmacy, DME and point-of-sale systems share patient,
doctor and vendor records, as well as creating data entry efficiencies
while reducing errors. Such a system also ensures better management of
From the customer’s perspective, they are better served because a
single transaction can process pharmacy, DME and OTC items, or bill
them in a single statement. Likewise, only a single signature at the POS
is required for prescriptions, HIPAA, counseling, Medicare Part B documents
and credit card transactions.
Many vendors offer their systems via a cloud-based, software as a
service (SAAS) model that’s similar to leasing a car — you get the product
for a monthly fee, and the provider gives you the software, maintenance,
updates and tech support as part of the deal. The pharmacy might pay
a little more monthly, but it doesn’t have to make a big down payment.
Also, staff doesn’t have to do as much training and maintenance. Also,
cloud-based SAAS offerings reduce costly and potentially unreliable
infrastructure requirements for the pharmacy.
The key is to remember why you’re doing this. Whether it’s integrated or
a new install, implementing a software solution that lets your pharmacy
seamlessly serve up both pharmaceuticals and funded DME turns your
pharmacy into a one-stop-shop, and save clients from making a trip to
another store for their DME.
This capability further emphasizes your pharmacy’s value in your
community. Patients will know that you are a trusted source of much
more than filling prescription drugs. Moreover, physicians will know this,
too, and begin referring more patients to your business. So, whatever
headache or cost a DME software implementation might seem like at the
outset, it will pay big dividends over the long haul.
This article originally appeared in the DME Pharmacy December 2019 issue of HME Business.