Pharmacy Billing and Reporting

Transparent, Simplified Billing & Actionable Reports

Navigating the finances of medication in long-term care can be complex – but Custom Care works to make it as simple and clear as possible for both facilities and resident families. Our Pharmacy Billing and Reporting services are built on accuracy, transparency, and support. We aim to eliminate billing surprises and provide useful insights that help you manage costs.

Dedicated Billing Specialists: We assign a billing specialist to each client facility, meaning you have a go-to person for any billing questions or issues. Your Custom Care billing specialist is well-versed in the insurance landscape, Pennsylvania’s Medicaid rules, and private pay procedures. They work closely with your administrative or business office to coordinate coverage for each resident – whether it’s Medicare Part D, Med A (for short-term rehab stays), Medicaid, or other third-party plans . Because we keep billing inhouse (we do not outsource this function), you’ll always talk to someone who understands your account and can resolve things quickly.

Insurance Coordination & Claims Management: We handle the heavy lifting of dealing with insurance claims and paperwork. Our team will bill all eligible medications to the correct payer source – making sure, for example, that Medicare Part A covered medications (for a resident in a skilled stay) are separated from Part D covered meds, etc., so that the facility isn’t inappropriately charged . We use “split-billing” techniques to ensure once a resident transitions from a facility-covered stay to regular coverage, the charges shift accordingly and do not hit your facility’s bottom line beyond what’s necessary . For Medicaid pending residents, we can manage patient pay vs. Medicaid portions and adjust as status changes. We also diligently pursue prior authorizations and work with prescribers to find covered alternatives whenever a drug isn’t covered, minimizing those pesky “non-covered” charges . Our goal is to maximize insurance utilization and minimize out-of-pocket costs for residents and facilities alike.

Monthly Statements & Clarity: For any portion of pharmacy services that a resident (or their family) must pay – such as copays, spend-down, or private pay items – we provide easy-to-understand monthly statements. Each charge is clearly listed with the medication name, date, and amount. We time our billing cycle to align with the calendar month and can coordinate sending statements either to the facility to distribute or directly to the financially-responsible party, per your preference. Our invoices are designed to be straightforward, and our billing team is available to explain any line item if there are questions. We pride ourselves on clean, accurate invoicing that doesn’t leave people scratching their heads. HealthDirect (one of the large LTC providers) calls this a “Clean Billing System” that produces easy-to-understand invoicing and manages copays internally – at Custom Care, we embrace that philosophy as well.

Direct Billing to Families: In personal care and assisted living settings, often families handle their loved ones’ pharmacy bills. We take the burden off your facility by billing residents’ responsible parties directly for any charges not covered by insurance (unless you prefer a different arrangement). This means the facility isn’t stuck in the middle of collecting medication fees. However, we still coordinate closely with you – for example, if a family is not paying and a balance grows, we will notify the facility so we can work together on a solution to avoid disruption of medication supply. Our priority is that the resident continues to get their meds, and we handle the financial follow-up in the background professionally and discreetly.

Online Access & Payments: We offer an online bill pay portal through our website, as mentioned earlier, to make it convenient for families or residents to pay their bills . They can also view recent invoices there. This digital option is secure and available 24/7, which today’s tech-savvy family members appreciate. It tends to improve timely payments and reduce confusion, as users can see their statements and receipts at a glance.

Cost Management Consulting: Billing isn’t just about sending invoices – it’s also about helping you manage and reduce costs. As part of our pharmacy consulting, we provide cost management services (see Pharmacy Consulting > Cost Management for more details) that naturally tie into billing. For example, we run reports on your facility’s top 20 costliest medications and explore if there are cheaper therapeutic alternatives or if any regimens can be simplified to save money . We’ll alert you to any unusually expensive orders before dispensing when possible (for instance, a brand-name drug with no coverage – we’ll call and discuss options like switching to a generic or different med rather than just filling and billing you unexpectedly). Our pharmacists might recommend formulary adjustments that could shave significant dollars off your monthly pharmacy spend . In short, we actively look out for your financial interests and not simply dispense blindly.

Comprehensive Reporting: We generate custom reports to give you insight into your pharmacy utilization. Some examples of reports we can provide regularly or upon request:

• Monthly Utilization Report: Detailing number of prescriptions dispensed, by payor source (Medicare, Medicaid, private) and by category (routine vs. PRN vs. OTC). – Cost Trend Report: Tracking your facility’s total pharmacy costs month over month, highlighting any spikes and the reasons (e.g., new high-cost residents or therapies). This can help in budgeting and management meetings.
• Consultant Pharmacist Reports: If our consultant pharmacist performs medication regimen reviews, those findings/recommendations can be compiled (e.g., number of recommendations made, types of issues found like duplicate therapies or high-risk meds, etc.). This demonstrates quality improvement efforts for your records.
• Formulary Compliance Report: If you have an internal formulary or preferred drug list, we can report on adherence to it and identify any off-formulary uses that might be switched to save money.
• Regulatory Reports: For assisted living in PA, while not as tightly regulated as nursing homes, you might still benefit from data like psychotropic medication use trends, antibiotic usage (for stewardship), or controlled substance accountability. Our system can produce such data if needed for your QA meetings or state surveys.

Issue Resolution: In the rare event of a billing discrepancy or error, we address it promptly. Perhaps a medication was discontinued but still appeared on the bill – just alert us and we’ll research and correct it, issuing credits as appropriate. We are committed to fair and accurate billing. Our 99% client loyalty among those we serve is partly due to our trustworthy billing practices and willingness to go the extra mile to rectify any concerns.

Ultimately, our billing and reporting services provide clarity and control. We don’t want pharmacy costs to be a mysterious black box for our clients. With Custom Care, you’ll always know what you’re paying for and why, and you’ll have a partner helping you manage those costs responsibly. By combining personalized support with efficient processes and insightful reporting, we turn pharmacy billing from a headache into a smooth, predictable part of your operations.