COPPELL, Texas -- Minyard Food Stores has shifted reconciliation of third-party plan payments to an outside service, so far with good results, according to Bruce Jacobson, pharmacy coordinator. Minyard operates 77 grocery stores, which include 31 pharmacies.
Stores has been in getting a tighter handle on claims that were falling through the cracks and making sure we are getting paid on a timely basis," said Jacobson.
The reconciliation system supplies Minyard with a detailed listing of third-party billings and rebills third-party plans if reimbursement is not made within the guidelines. The system, now being fine-tuned, has been in place at Minyard for nearly a year. It is just starting to pay for itself, said Jacobson. A big advantage of going off-site for the service is that no new equipment or staff or additional training was required, he added.
"Now we always know the status of each third-party claim, what's been billed, what has been collected, how much is outstanding and how long it has been outstanding," said Jacobson. "The next step is to go back to third parties and ask, 'Why haven't we been paid?' "
Having such information and control have become more important as third-party prescriptions have increased to account for a third of the prescriptions Minyard dispenses, up from 15% four years ago. It is also helping the chain plan for the future.
"More increases in third-party business are coming," said Jacobson. "We know it's already in other parts of the country. Health care reform is going to make the number of third-party customers grow even faster." "Pharmacies worry about two things: if they are going to get paid, and did they get paid," said Mike Mastromonica, vice president of marketing at Condor Corp. "Just because the adjudicating plans say you're going to get paid, that doesn't mean that the money is going to find its way to you."
Reconciliation of claims is a growth area for Condor, said Mastromonica. Others using the service include Thriftway, a Cincinnati-based grocery chain, and Super D Drugs, a drug chain based in Memphis, Tenn.
"We were already collecting this type of data here internally," said Mastromonica. "So for us to collect submission information and then payment information incrementally is not difficult. It's a value-added service." Unlike the Rapid RxEmit service offered by The Pharmacy Fund of New York, Condor provides only a reconciliation service; the retailer retains ownership of the third-party receivables.
"We estimate that this service could save Minyard as much as 2% in operating expenses," said Rich Andersen, director of customer information services at Condor, "by reducing write-offs, cutting collection time and allowing them to make decisions based on the exact information they need in regard to third-party claims." Cash flow is improved, and there is better control over accounts receivable and billing errors, he said.
"We're still trying to evaluate the exact benefit to the bottom line," Jacobson said. "But we know that to do at Minyard what we are now doing off-site with Condor, we would have had to hire more people and go through a pretty aggressive learning curve."
