Independent Pharmacy Accounting, Pharmacy Growth

This is why you don’t “fill and pray” – The Bottom Line Pharmacy Podcast

Dear independent pharmacies:

When you have potentially thousands of dollars a month in unreimbursed claims, you can’t leave it up to chance that you will receive that money, or as we say, don’t “fill and pray.” Get your third-party system up-to-date through automation tools available today…and get paid!

Thanks, Lindsey Daniel, senior manager of reconciliation at EnlivenHealth* for joining us to talk about automating pharmacy reconciliations on this very important episode of The Bottom Line Pharmacy Podcast.

*This is an educational discussion between likeminded professionals. Sykes & Company, P.A. employees were not compensated, nor were any vendors compensated for being on the show.

The Bottom Line Pharmacy Podcast is your regular dose of pharmacy CPA advice to fuel your bottom line, featuring pharmacists, key vendors, and other innovators.

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If you prefer to read this content, the video transcript is below.

Kendell: Okay, so welcome to this episode of the Sykes & Company, P.A. Bottom Line Pharmacy Podcast. Today, we have a special guest, Lindsey Daniel. She is with Enliven, and she has been their senior manager there of reconciliation. So we look forward to doing a deep dive, well, not a deep dive, but going over some of the basics of the reconciliation process. So tell me, where are you from, where are you at? A little bit about yourself. Let the audience know who they are going to be listening to today.

Lindsey: Yeah, hey you all. Thanks for having me on today. It is great to be here. Like Kendell said, my name is Lindsey Daniel. I am the senior manager of reconciliation at EnlivenHealth, which is formerly FDS Amplicare. I have been here roughly nine years now. I started out performing the reconciliation. So what my team does today for our pharmacies, I have a passion about recon, helping our customers manage their financial business, and just getting to know our solutions and what we have to offer. And just a little bit about EnlivenHealth. EnlivenHealth builds advanced software solutions that help community pharmacies improve the health of their patients and their business. So EnlivenHealth acquired FDS Amplicare and MarkeTouch Media in 2021. And now EnlivenHealth offers the industry’s most comprehensive software suite, including solutions for patient engagement, financial management, clinical services and business intelligence. We currently service 50,000 pharmacies nationwide. So my focus is in the reconciliation and medical billing space. And again, I just have a passion for helping our pharmacies manage their financial portfolio.

Scotty: Yeah, you guys cover a lot of different solutions for pharmacies, for sure.

Lindsey: Definitely.

Scotty: But the one we want to focus on today obviously is the financial solutions, the reconciliation, the medical reconciliation, which has kind of taken off nowadays. So Lindsey, you know, we have a good relationship with you guys. We work with a lot of mutual pharmacy clients, and we often hear pharmacies out there that either do not have any reconciliation in place at all, they are doing it by hand, or they do not even keep up with the reconciliation systems they have in place. Maybe it is the Enliven system, they are just not managing it or doing what they need to be doing on that end. Can you talk to, maybe a little bit about, you know, why pharmacies, in your opinion, need to have this system in place and the benefits that it can provide to pharmacies?

Lindsey: Yeah, definitely. I think to answer that, you know, we kind of have to start with what is reconciliation, and what is that service, and what does it offer? So reconciliation in simplest terms is just making sure that you are getting paid what you are billing out. So, you know, you have patients coming in, you are dispensing that medication, that medication is out the door, right? And now you have to wait for those PBMs to pay you, and that could be 60 to 90 days down the line. So are you sure that you are getting that money if you are not tracking it? You know, do you know this $100-script… You are getting that $100 back, or are you just giving away your product for free, basically? So that is where reconciliation comes into play. I like to think of reconciliation as an insurance policy, just to know that you are getting paid, right? You check your bank account every other week to make sure you have your paycheck, you know, so you can pay your bills, that sort of thing. So recon is that insurance policy to make sure that you do have those funds available to pay your bills, to pay your staff, to be more involved in your communities, to serve your patients. So that is essentially, you know, what recon is and why I think it is important. And again, it is that insurance policy. So while I think a lot of pharmacies may assume that it is about recouping funds and finding that lost money, that does not always happen. It certainly does happen, right? You know, I have had pharmacies where they have EFT set up, and there was a banking error to where $10,000 just was not deposited, because the bank stopped all their funds. So you hear a lot of, “Well, I have EFT set up, I am not worried about it. I am getting my money.” Well, are you? Are you sure? If you are not reconciling, how do you know? You know, it is the same thing with checks getting lost in the mail or claims that just go unpaid because they were missed for whatever reason. So that is where recon comes into play to where if it does happen, you are tracking it, and you are able to know much more quickly that you are missing these funds or that something is happening with your financial business.

Bonnie: And we have a term that we actually refer to with that method around here. Like I said, we have met a lot of clients who come to us and they have not been doing anything at all. And we like to call that the “fill-and-pray” method. So that is where you just fill the script and you just hope that you are going to get paid, which is just terrible in my opinion. I mean, we cannot do that. You have got to make sure, because some things are just, you know, I had a client a few weeks ago that just started to see that she was having some, her cash flow just seemed low all of a sudden. And she is like, “There is no real reason for that.” And she had, you know, checked out some other things to make sure those were not the causes, and they were not. And so she is like, “I just do not understand.” And so when she really started to look at the reports that you guys have, she was able to start to see that she had not been, just one of her payers had stopped, she stopped getting money, and there was a reason behind that when she dug into it. But if she was not… if she did not have those reports, if she did not know, how would she ever track that down and know?

Scotty: That happens all the time. I mean, you hear that kind of stuff all the time. You really do. But another saying, Bonnie, we have.

Bonnie: I know what this one is.

Scotty: Other than the the “fill and pray” is the largest unreconciled bank account in your pharmacy. And, you know, we reconcile our pharmacy bank accounts every single day. We are going in there reconciling and keeping it up to date. So not having your finger on the pulse of what is going on with what you are adjudicating, receiving, and so forth is not good. I mean, you got to have that system in place. You got to know where your receivables are if you are getting paid. And I know you have heard a lot of horror stories, Lindsey, you know, issues with reconciliation and not being paid, and so on and so forth. I mean, we have heard the same thing, so it is very important to make sure you are keeping tabs on that. So what are some, so that is kind of what reconciliation is, why it is important, and also it is just important in general for your financial picture overall when you are running financials and analyzing how your pharmacy is performing: your margins, KPIs and so forth. What are some of the best practices or maybe even service levels that you guys have with the Econcile platform, and maybe some best practices with that? Because I know we have a lot of pharmacies that use the system, but maybe they do not know the best practices or how to maximize the system in general.

Lindsey: Yeah, definitely. So we have two service levels that we offer. One is a self-service model. So as opposed to, you know, maybe manually tracking things on a spreadsheet, we offer you our solution, our technology, to where most everything is going to be automated for you, but you still need to log in and verify your deposits to make sure you have those funds in your bank, work what we call payment exceptions, and those are claims that did not pay as you were expecting. So I know sometimes, you know, we are just looking for what did not get paid, but what did not get paid in full? So that is, you know, there are things to manage there. In situations where maybe we are not getting the electronic files for your deposits, manually entering those paper EOBs, that way you are on top of what is coming in and your aged receivables is staying up-to-date. So that is kind of our general self-service platform, I recommend logging in probably multiple times a week for that. You know, daily is honestly the best, so you are on top of it, and it is less time that you are having to spend at the end of the week or the end of the month to get it cleaned up. And it is going to take time, you know, for our pharmacists or for our pharmacy owners to go in and do that. And we also offer what we call a full-service model. So our Econcile Complete solution, and that is where you essentially put 95% of that work into my team’s hands. We have a team of analysts that manage your aged receivables as things are older than 60 days. You know, where is that money? If you have paper remits that need to be entered, my team does that for you. And then payment exceptions, if there are things that maybe the payer is not paying or underpaying, things that are missing, we do all that legwork with the payers on, you know, the pharmacy’s behalf, so they can focus again on their patients. They do not have to spend this time reconciling, because we are doing it behind the scenes. And I think just best practices for that, again, you still need to verify deposits. We do not have access to your bank account, we do not want access to your bank account. So just log in, you know, once a week, spend 15 minutes going in and checking those off in our system. That is the critical piece, because that is what starts reconciliation, and that is how we can reconcile those claims. The next piece, like I said, you have a team here, there is one lead rep that is in charge of your account. They will be reaching out just with, you know, “Hey, this is what I see in the account. Are you aware of this?” kind of thing. So just being engaged with them. If they are asking for information, if they are needing paper EOBs, that sort of thing. Just stay engaged, answer them, provide them with the information that you need. So again, at the end of each month, quarter, a year, your aged receivables is up-to-date, and we are not, you know, having to go back and try to clean up what is out there.

Kendell: And I have a question. So those two, the more self-service, and then the one that they are kind of putting a little bit more on your team’s hands, what are the names of those service levels? Are there specific names, if someone, you know, wanted to sign up for them?

Lindsey: Yeah, so the self-service model is our Econcile Auto, and then our full service is Econcile Complete.

Kendell: Okay. And you said, rather than to reconcile it on a spreadsheet, I have to ask, are pharmacists really trying to reconcile all of this?

Lindsey: They are, yes.

Bonnie: I see it.

Kendell: Oh man, oh God, oh man.

Lindsey: Yeah, I have seen it. I have heard those stories, and they get into our solution, and they are like, “This is so much better.” Just having that automated, you know, solution. We are getting your data, we are getting your 835s, the system is doing a lot of that work, a lot of that matching. So if it is paying what it is expected to pay, you do not even have to look at those.

Kendell: Oh wow.

Lindsey: Whereas, if you are manually doing it, right, you could be filling 7,000 claims a month on average. Those are 7,000 claims you are having to look at individually. Whereas you know, having that technical solution, maybe there are 30 claims a month that you are having to review or you know, something much more manageable.

Bonnie: So Lindsey, let me ask, what is… because I know you see a lot of this, what would be, for a busy pharmacist, so we work with a lot of independent pharmacists who, you know, their time is very limited, and I know this can be somewhat of a tedious process, even if it is not that much per day, it is still, it is kind of like payroll. Sometimes we say, “Please do not do it. Outsource that. You do not have time for this accounting. Like let us handle it. You know, you handle the pharmacy.” So in an optimal situation that you see works the best, what would be the best scenario? Do you see pharmacists kind of maybe have a tech that helps them with that, that is their dedicated duty, like an employee there at the store? Or are they just having to find the time to do it on their own? You know, what works the best that you see?

Lindsey: I think the pharmacies that we work with, it is generally, you know, working with techs, somebody that they have hired, you know, into their pharmacy. Because our owners, our pharmacists, their time is tied up in all of these other things that they are trying to do for their patients. Not to say that they cannot do it. It is just, you know, more time spent on them, even, you know, on the Complete model, 30 minutes a week, that is probably 30 minutes that they just do not have, right? They might be doing it at night when they get home answering their emails and you know, those are just things that they do not necessarily have to do. So we do work with a lot of techs or we work with a lot of accountants that may be in their office, that sort of thing. That is their focus.

Bonnie: Gotcha.

Kendell: What would be your message? What would be your message? Maybe you can help us all out giving a message to the pharmacists that are listening, to those who say, “Well, I just enjoy it, and I will get to it when I get to it. I just want to do it myself.” We have a lot of pharmacists that become attached to certain duties, but then they do not get to it, unfortunately. What would be your message for them?

Lindsey: Yeah, I think, again, just back to the importance of staying on top of your reconciliation. It is more than just, you know, making sure you are getting paid, right? There is a whole financial suite of reports that we offer. Tracking your DIR fees, you know, are you aware?

Bonnie: That’s a big one.

Lindsey: Are they? Exactly. Are they increasing month to month? If you are not out there looking at it or doing it, like how do you know what is happening? How do you know what funds you can expect to come in so you can pay your bills next month? You know, how are you doing that financial planning on your side if you are not actively looking at it? I know, you know, you might say, “When I get the time,” well, when are you going to have the time, right? Your patients are important, your patients need you, and I feel like that should be your focus. Let us handle your financial needs.

Scotty: And we love those DIR fee reports that come out of the system, because as we know and as we talk about all the time, you know, DIR fees are your third largest expense now, behind cost of goods, behind payroll. So having your finger on the pulse of what is going on with DIR fees is critical. So those reports are able to give you that information. You get into your accounting system, now you can see where your percentages are with DIR fees. Are you below, are you above average? And then you can take action maybe to some degree to make adjustments with those DIR fees. So those reports are great for sure.

Kendell: And what other big reports do you see that are utilized by pharmacists? I know, and if you could speak to a little bit, I know there are some aging reports that we look at a lot internally, but are there any other specific reports or… not to get too detailed-oriented, but what are pharmacists looking for when they look at reports, generally?

Lindsey: Yeah, so I think, you know, in our system we have just kind of the recommended reports at the top, right? These are the ones at minimum you should be running. So we have our aged receivables, month end. That is just a static report that shows you exactly where your AR is month-to-month. And you can run that at any time, and it will not change month-to-month. And then at the end of the year, especially. So that is important, because again, it is telling you, you know, where your funds are, what is tied up, what has been paid or not paid. So we kind of start with that one. That is, you know, the number one report that we recommend. We also have claims reports that show your sales for the month. So we recommend you look at those, so you can see what you have billed out, and what you can expect, you know, to receive in the next 30, 60, 90 days. We have our paid report, so what has been posted in the system, so claims that were paid, if there were variances, and those payments, you know, overpayments, underpayments, partial payments if you have vouchers, things like that, so that posted report. And then the DIR fees. DIR fees are important, but it is also important to note that there are other adjustments being taken out of these checks. So we do have the report that is kind of all-encompassing of your transaction fees, your forwarding balances, your DIR fees, everything in one, because while DIR fees are probably the largest, there could be a couple thousand dollars here or there, a month, being taken out in other areas. So those are all reports that we recommend you look at at minimum once a month, at the end of each month.

Scotty: And I got to say, it is a very user-friendly platform you guys have, because I get in there every now and again and play around with it, so it’s very friendly. I did not mean to cut you off there Lindsey, but I want to ask about the verifying deposits, because I have seen pharmacies that will verify once a month versus, you know, once or twice a week, which we highly recommend you do. And that can throw off the aged receivable reports in terms of timing and things like that. So you will have a big month of high AR, and then the next month after you verified, it can drop, so it can kind of skew those numbers if you are getting those numbers into your financial system. So having that reconciliation or the verifying deposits, and getting into a system, a routine where you are doing that consistently is important.

Lindsey: Yeah, if you are doing it twice a week, it should take you five, 10 minutes max each of those days to go in and do that. And you know, we cannot reconcile until you verify it. That is what starts the whole process. So you might go the whole month, if you are still looking at your aging, it is going to be inflated for that entire month. So you are going to think that you have more money coming in than you actually do, because you probably already received it. So just going and spending those few minutes every week to do that, it will honestly be easier on our pharmacists to just do it more regularly.

Bonnie: And just so everyone that is listening, you know, really understands from an accounting perspective, the way we look at it, when we look at financials and we are looking at your balance sheet, and like you said, we do this, we have our hands in it every day as far as our reconcile, you know, cash balance scenario, but we also at the end of the month, I mean we are going in, you know, line by line on the balance sheet and adjusting to these numbers that we are talking about, and two of those big numbers are inventory, which is why, you know, it is important that we get a perpetual number from a perpetual system. And also the other big number is receivables, and that is why this is so important to us, because, like you said, even if you are using a platform like yours, if you are not reconciling it correctly, and we have inflated numbers or deflated numbers, whatever the case may be, if the number is not right, and we use that number to do the financial statements, to adjust to those, obviously that is going to have an impact on sales, and the bottom line and your gross profit. So, sometimes we pull those reports, and you can look at it and know enough to know that that cannot be right. That is really high. And if you use that number, then like you said, receivables are inflated, and then our numbers are not really giving us a true picture of how that pharmacy is operating. So it is not only important, like you mentioned, I just want to point that out that we use a service like this, but that we also use it correctly, because to get correct numbers, and then that just goes through the whole process. Your taxes, your financials, your KPIs, if you want all that information to be correct and you really want to understand how your pharmacy is operating, you know, you have got to do this correctly and make sure you have the correct information.

Scotty: And we look at enough of these third-party reports every single day, where we can pretty much pick out when there is something not right in these reports, and then we can go to the client and say, “Hey, you know, maybe you are missing something here.” But yeah, it is very important from that accounting side, and from knowing those numbers for sure. So Lindsey, why don’t we switch gears, how about to the medical billing side. You know, we have got some pharmacies dipping into the medical side, you know, whatever it is with vaccinations, or IVs, or whatever comes with the medical side. Kind of talk on that system and what you are seeing there in terms of maybe growth in seeing pharmacies expand into that medical side, or perhaps how is that system different than the normal reconciliation with the scripts?

Lindsey: Yeah, I think the medical billing system, especially in the last two years, has just taken off, right? Because pharmacists, their licenses are expanding. They are able to do more point-of-care testing. The COVID vaccines and tests, those types of things have really, you know, tripled, and I do not even know how large it has grown in the last two years for us, but it is a large business. So our medical billing solution offers a way for pharmacists to bill their claims to Medicare, to other commercial payers, under that medical benefit. We act as a clearing house, so you know, you submit your claim through us, you can do it through your PMS system, it is easy. Work it into your day-to-day workflow. We will scrub the claim. If there are issues based on the rules of of Medicare or these other payers that we are aware of, we can send that claim back to you, because the way that Part B adjudication works is it is not real time. The claim adjudicates when they issue the payment to you, so it could be three weeks before you know if you are getting paid for a claim or not or if there was an issue on it. So it is important to have a clearing house like our medical billing solution in order to get a clean claim through the first time, because again, that medication has already walked out the door, that item, you have already given that shot, we want to make sure that you are getting paid timely, so we work hard to make sure that those claims go through clean that first time. And then from there we also offer the reconciliation solution for medical billing claims. It is a little different than our pharmacy claims, because generally there is that 80-20 split, so Medicare is going to pay it, they may forward it over to, you know, the other payer, and then you have to wait for that 20% to come in. Is there a fee for the patient that they have to pay? So again, just having that visibility and not having to read paper remits to determine was my claim denied? Was my claim paid correctly? Is there a patient responsibility I need to go after? So that that medical billing system is really kind of that start-to-finish billing service for those medical Part B claims.

Kendell: That has been huge. I know a lot of pharmacists I have worked with were really worried during the vaccinations. Like, they were saying during COVID, “Am I getting paid for what I have done? How do I know what I am getting paid for? How do I know when it is coming?” There was delays. So I think that is going to be something that is going to be more and more important to stay on top of for pharmacists.

Lindsey: Definitely, I think medical billing is going to keep expanding, right? As we are working, again, expanding their licenses, what they are able to do and getting more into those medical services. I think, you know, if pharmacies are not doing it today, then I think they need to, you know, do their research on how to get into that medical space. And again, we offer that solution. We offer guidance there, and we have pharmacists on staff that they can talk to as well about what that looks like for them.

Scotty: Awesome, good stuff. And you guys go to all the major trade shows and things like that, so feel free, anybody listening out there to stop by, and sometimes you will see Lindsey there as well, if you get lucky.

Kendell: I was going to ask, just how would someone get in contact with you if they want to ask you some questions about the third-party process? What is the best way to get in contact with you?

Lindsey: Yeah, so I think through our website if you are interested in learning more, the website is just EnlivenHealth.co. There is information about our solutions there and ways to get in contact with somebody from our team. Or you can reach out to Sykes & Company, P.A., because we have a great relationship with them, and they know how to get to me directly as well, so.

Scotty: I will give a shout out to Kathy. She is our in-house third-party reconciliation guru if you will. She works closely with Lindsey. So she is available to help anybody that has questions as well. You can always reach out to Sykes & Company, P.A. here. We will do our best to help you.

Bonnie: And I would say too, even for current clients of you guys, that are, you know, we have some mutual clients, obviously, and you know, sometimes people will put their hand up, and we find out they are having issues later. The same thing happens sometimes with us. Maybe they do not understand something that is going on in their financial statement, and then they wait a couple months to say something. Like, put your hand up, would be my biggest takeaway from a lot of this. If you do not understand something that is going on with the third-party reconciliation service, maybe you do not feel like you have got the training you need, you are just, you know, clueless, like I feel like a lot of times with lots of things, put your hand up, call your analyst, and let you guys know that there is an issue. Because I know you guys will help, and sometimes you just do not know that there is an issue, and we find that a lot. You know, people, “What is going on with your report?” “I do not know.” “Well, have you called?” “No.” You got to say something. So we see that a lot, and it is not your fault. A lot of times it is the client that just does not know. They just kind of put it on the back burner, which we all do with certain things, but to me this is huge. If I had a pharmacy, this would be something that would be really important to me. It would be different if this was like credit card reimbursements, you know? You get those after every few days, and so you could tell quickly if there is an issue, but with this, like you mentioned earlier, could be, you know, 30 days, 60 days, sometimes 90 days for reimbursement for claims, and so it is so important. You have to have your hands on what is going on, because you are never going to be able to keep track of it otherwise.

Scotty: Well, it is such a large number too.

Bonnie: So, yes, it’s your biggest number, yeah.

Scotty: I guess probably the average is $250,000, $300,000 receivable number any given month. That is a lot of money, you know? And that impacts your numbers.

Bonnie: That is your cash.

Scotty: I mean that impacts the whole financial picture. So you just got to have your hand on this and yeah, so you know, if you are not doing it, you need to be doing it. You need to be using technology 100%. You absolutely should not be manually doing this process.

Kendell: Oh no, please.

Scotty: Utilize technology.

Kendell: Please do not be on Excel.

Bonnie: It is just another example of all these other things with technology that we mentioned. It is just so important for the pharmacy owner to get out there, spend their time in other places. And spending it doing, not that this is not important, it is extremely important, but it is not somewhere where we feel that the… just like with accounting, that the pharmacist should spend their time. They should be helping their patients, growing that pharmacy, working out front, building relationships, working with providers. So this time should be spent, you know, passing this along to some of your employees that you trust and that can help you with this, and let that owner spend their time in other areas.

Lindsey: Yeah, and I think it is, like we kind of mentioned on the DIR fees a little bit earlier, right? It is not just, where is my money? It is, you know, tracking those different things. And I think one important callout for our pharmacies to be aware of is, you know, in 2024 there are changes coming out to the DIR where it is going to be taken at the point of sale, versus retroactively. And it is important to plan, you know, in 2023 for that, because that first quarter of 2024, they are not only going to be taking it at the point of sale, but they are also going to be taking those retroactive Q4 2023 fees. And so that first quarter is going to be tough, because it is essentially like you are kind of getting double hit on those fees. So I have talked to many pharmacies, they are already planning today, leveraging our reports to kind of get an idea of how much is being taken out quarter-to-quarter, and they are already setting funds aside. I think the power just went out in this building.

Bonnie: Oh wow.

Kendell: Oh wow.

Kendell: This is going to be a first. We have never had the power go out.

Lindsey: But I am on my phone, so.

Bonnie: I did not know if you were just changing the lighting or something around that.

Kendell: This is a dramatic lighting change for the DIR fees coming in 2024. For those who are listening, the lights just, like a spotlight on Lindsey.

Bonnie: Love it.

Lindsey: I do not know if you want me to finish up.

Bonnie: No, you are fine, keep going.

Scotty: Let’s roll.

Lindsey: Yeah, so, you know, we have pharmacies already planning today for that change, so they are putting funds aside to where, when they are taking them at the point of sale and retroactively for that first quarter, their financials are not hit as hard. Because they already have that backup.

Scotty: I do want to ask, you know, the DIR fee change is coming, we are going to have some content out on that soon, but how can pharmacies out there utilize, how would you recommend pharmacies out there utilize the Econcile to help them with their planning? What would you tell pharmacies out there to help them prepare for that change?

Lindsey: Yeah, so I think we offer, like we mentioned, the DIR reporting. We do have a year-to-date report that basically gives you the entire year summary by month, so you can track it by quarter. So I think, you know, leveraging that report along with some of our sales reports, so they can maybe get a percentage of their sales per month of what DIR is, and then just plan to have those funds, you know, in advance. Kind of set that aside so you are available, but really just kind of doing that analysis of your DIR to your sales, so you get an idea of what, you know, like I said, it may be a double-hit that first quarter. So what does that look like, and how can you get ahead of that?

Kendell: And wow, this has been great. I had a list of things I wanted to go over, or hear, or learn, and I learned them all. One last question I personally have is what is the first step? You know, I have been filling and praying as a pharmacist, just been filling and praying.

Bonnie: Is that going to be the title of this podcast?

Kendell: That might need to be.

Bonnie: I think it is.

Kendell: Fill and pray.

Lindsey: I like it.

Kendell: I have been filling and praying, and the first, I am assuming the first step is to choose a provider. Let’s say I go to your website, how long until I am up and running? Meaning until things are coming in the system. Is it days, is it weeks, is it months, is it years? How long does it take for me to move from fill and pray to an actual, more of a sophisticated system?

Lindsey: Yeah, so if you go to our website, you enroll in our solution, right? You would work with our sales team, they would get the contracting process done. That, you know, could be a quick process, or, you know, it could drag out a little bit just depending on, you know, questions that you have, and you know, demos that maybe you want to see. But that could be a quick turnaround time. But once we have that executed contract, it goes to our onboarding team, and our onboarding team works to set up a data feed. So getting that information from the pharmacy management system or from the switch, of what is being adjudicated, so we get that set up. That is usually pretty quick; it takes a couple days. What takes the longest is working to set up the electronic 835 files. So the electronic payment files of what was paid. Some payers turn it around in a week. Some payers turn it around in 30 days. It just depends on the payer. But our goal is to have everybody onboarded and live either on the solution, managing it yourself, or with our analyst team here with me, within 60 days. And that timeline really depends on getting the forms back to us. So again, being engaged.

Scotty: Hey, Lindsey. What an interesting episode we have had here.

Bonnie: Yeah, she is sticking with it though.

Scotty: We have lost power. We have talked about one of the most important balance sheet line items, third-party. So I guess with all this, Lindsey, we usually wrap up with the bottom line. Like, what is the bottom line take away for you? So I will start, you know, my bottom line is you got to have reconciliation, it has to be automated, and you have to be keeping tabs on it consistently. It is the largest unreconciled bank account if you are not keeping on top of it. And the fill-and-pray method is not a business strategy. So “get a system in place” would be my bottom line here.

Bonnie: You just took three of them.

Kendell: Yeah, like four.

Scotty: I did. That might be the whole bottom line.

Kendell: Every bottom line imaginable on the topic. No, I was just going to say, I guess for me the bottom line is, we just talk about knowing your performance, so it is not just making sure the cash is coming in, but knowing your performance. Keyword, accrual accounting, and if you do not have third-party reconciliation, you do not have accrual. So if you want to know how you are doing and be able to make decisions, then getting involved in making sure your third-party is accurate and up-to-date is essential.

Bonnie: Yeah, and I would say, you know, us CPAs, on a selfish level, we really like it when you guys have good reports and are using a group like this to keep things reconciled, so that we can use the correct numbers for you as well. And I did love what I learned today from Lindsey. It is not just about making sure that you are getting paid, it is all these other, you know, these reports and things, to the DIR fees we mentioned. You know, it is important to have that information, and making sure that you are getting the right amount. So that is something that I have not really, I mean I know, but I have not considered a whole lot. It is not just that you are getting paid, but that also it is the correct amount.

Scotty: Lindsey, how about you? What is your bottom line take away for the listeners?

Kendell: Did we leave her any meat on the bones?

Bonnie: We didn’t leave her much, but.

Scotty: The bottom line is…

Lindsey: It is hot over here in Texas, the air is off.

Scotty: You need to get some power at your place.

Lindsey: No, it is fine, I think, like I have said, just being engaged, right? So if you are using our solution or plan to use our solution, use it, right? Be engaged, use our analyst, call them, verify those deposits, help us stay on top of it for you, so we do not have to, you know, go back and try to get information that may not be available anymore. So, just be engaged.

Bonnie: Awesome.

Scotty: Very nice. And you know, I wanted to harp on how being engaged with those analysts is very important, so I am glad you mentioned that. But Lindsey, we certainly appreciate you joining us half in the dark, and the other half.

Bonnie: Thanks for sticking through, Lindsey! She is a trooper!

Scotty: Yeah, what a trooper here. Thank you for all the help you provide for our clients, working with Kathy and our clients directly. And we certainly appreciate you and all you guys do, and appreciate you joining us here today. So Lindsey, thank you so much, and we will have to do this again sometime. Thank you.

Bonnie: Thanks, Lindsey, have a good day!


Additional reading: Optimize Your Pharmacy’s Third-Party Reconciliation


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