In the fast-paced world of pharmacy, accuracy and efficiency are paramount. Pioneer Pharmacy Software recognized this need and revolutionized the industry by introducing the first system with integrated Pre-/Post-Edit features. This innovative solution empowers pharmacies to dispense medications with speed and confidence, knowing that potential errors can be identified and rectified before they lead to costly mistakes or impact patient safety. PioneerRx’s Pre-/Post-Edit functionality is designed to provide peace of mind and optimize pharmacy operations.
At the heart of this powerful tool are two key components: Pre-Edit and Post-Edit. Pre-Edit acts as a proactive gatekeeper, evaluating prescription data before it is transmitted for processing. This pre-emptive check identifies potential issues that require correction, allowing pharmacists to address them upfront. Post-Edit takes place after claim adjudication, analyzing the claim data to pinpoint discrepancies or errors that may have occurred during the processing stage. With PioneerRx, pharmacies have the control to customize their response to each type of identified issue, choosing to reject, review, or ignore edits based on their specific needs and workflows.
This sophisticated system offers a wide range of applications to streamline pharmacy operations and protect revenue. Here are some key examples of how Pre-/Post-Edits in Pioneer Pharmacy Software can be leveraged:
Ensuring Accurate Reimbursement and Preventing Financial Losses
Several Pre-/Post-Edits are designed to safeguard pharmacy revenue and prevent financial losses arising from claim errors or contractual discrepancies.
- Base Limited (Post-Edit): Pharmacy contracts often rely on formulas like AWP – X% + Fee or MAC + Fee. The “basis” refers to the no-fee version. If a claim is sent with a basis lower than the contracted rate, third-party payers typically reduce the payment. PioneerRx’s Base Limited Post-Edit flags these instances, allowing for correction and ensuring proper reimbursement.
- Cash Limited (Post-Edit): Pricing errors can significantly impact profitability. This Post-Edit is crucial for identifying and correcting pricing mistakes that could limit third-party payments, ensuring accurate revenue capture.
- Third Party Remitted a Negative Amount (Post-Edit): In rare cases, a prescription claim might result in a negative remitted amount, meaning the pharmacy owes money to the third party. This Post-Edit alerts pharmacies to such situations, enabling them to switch the prescription to cash or another discount plan and avoid unnecessary fees.
- Low Profit (Post-Edit): Pharmacies can define minimum profit margins. If a prescription’s gross profit falls below this threshold, the Low Profit Post-Edit is triggered. Furthermore, Smart Profit Reject considers rebates and the last paid cost before prompting the edit, providing a nuanced profit protection mechanism.
Improving Dispensing Accuracy and Inventory Management
Pre-/Post-Edits also play a critical role in enhancing dispensing accuracy and optimizing inventory control.
- Package Size (Pre-/Post-Edit): Dispensing medications in incorrect package sizes can lead to errors. This edit is activated when an item that should not be broken down is filled with an incompatible dispensed size. Correcting these errors can contribute to significant additional revenue for pharmacies.
- Dispensing Item Out of Stock (Pre-/Post-Edit): Running out of stock can lead to dispensing delays and potential errors. PioneerRx’s integration with perpetual inventory systems helps prevent dispensing out-of-stock items, saving money and avoiding dispensing errors.
- Obsolete NDC (Pre-/Post-Edit): Dispensing medications with expired NDCs can lead to reimbursement reductions and audits. This Pre-/Post-Edit prevents the submission of claims with obsolete NDCs, mitigating these risks.
Enhancing Patient Safety and Data Integrity
Patient safety and data accuracy are paramount in pharmacy practice. PioneerRx’s Pre-/Post-Edits contribute to these aspects through several checks.
- DAW Code (Pre-/Post-Edit): When a brand-name drug is dispensed despite generic availability, a DAW code is required to justify the dispensing of the brand. This edit ensures that a DAW code is selected, preventing reimbursement reductions.
- Patient ID Missing (Pre-/Post-Edit): For certain dispensed items, patient identification like a driver’s license or social security number is mandatory. This Pre-/Post-Edit triggers if this information is missing, promoting patient data completeness.
- Patient Information Missing (Pre-/Post-Edit): Up-to-date patient information, including allergies, medications, and medical conditions, is crucial for safe dispensing. This edit is activated if this vital information is missing or outdated, prompting pharmacies to update patient records.
- Missing or Invalid DEA (Pre-/Post-Edit): Prescriptions for controlled substances require a valid DEA number for the prescribing physician. This edit ensures that a valid DEA number is associated with the prescriber, preventing regulatory issues.
- Missing or Invalid DPS (Pre-/Post-Edit – Texas): Specific to Texas, a valid DPS number for prescribers is sometimes required. This Pre-/Post-Edit ensures that the DPS number is present and valid when needed in Texas.
Optimizing Copay Management and Patient Communication
Pre-/Post-Edits can also assist in managing copays and improving patient communication regarding medication costs.
- High Copay (Post-Edit): Pharmacies can set a threshold for high copays. If a copay exceeds this amount, the High Copay Post-Edit is triggered, allowing pharmacies to verify with patients if they still want to proceed with the prescription before dispensing.
- Higher Secondary Copay (Post-Edit): In cases with secondary insurance, this edit alerts pharmacies if the secondary copay is higher than the primary copay. This often indicates issues with coupon configurations or third-party settings, allowing for prompt resolution.
In conclusion, Pioneer Pharmacy Software’s Pre-/Post-Edit features represent a significant advancement in pharmacy management. By proactively identifying and addressing potential errors in prescription processing and claim adjudication, PioneerRx empowers pharmacies to enhance efficiency, minimize financial losses, improve dispensing accuracy, and ultimately deliver safer and more effective patient care. This integrated solution is an invaluable asset for modern pharmacies seeking to optimize their operations and thrive in a complex healthcare landscape.
