Maximizing the Value of Your GeriMed GSO Contract
By Steve LaPeters, Vice President of National Accounts, GeriMed
In our experience, when we ask an independent pharmacy owner/operator what keeps them up at night, one of the most popular answers is, saving money! Most pharmacy business owners and managers would agree that maximizing reimbursement and staying profitable in the very competitive LTC space is quite difficult. It takes a very skilled pharmacy team with experienced and dedicated, trusted partners working alongside them to reach the same goal: maximizing reimbursement and profitability without sacrificing patient quality and satisfaction. With this in mind, GeriMed is a group purchasing organization offering unique contracts and pharmacy services to long-term care, closed door, and combo shop pharmacies all across the country. However, at GeriMed, we are more than just a GPO. We are a GSO – focused on a high expectation of our team to deliver THE BEST service in the industry to our valued clients. Our primary goal is to provide independent pharmacies with exceptional tools and services to help your business grow and provide quality care to your long-term care patients.
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We have crossed the midway marker of 2016, so pharmacies are focused on finishing the year in a strong and favorable financial position. We thought that this would be a good time to remind you of some of the outstanding service features GeriMed provides our member pharmacies.
Who We Service…
Closed Door Pharmacies
A “closed door” pharmacy provides LTC pharmacy services exclusively in a closed setting, and does not provide service to the general public. An example customer serviced by a closed door pharmacy is:
- Skilled Nursing Homes
- Chronic Psychiatric Facilities
- Assisted Living Facilities
- Home Infusion
- Group and Personal Care Homes
- Medical at Home
- Correctional Facilities
- Intermediate Care Facilities / Mental Retardation (ICF-MR)
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Combo Shop Pharmacies
One of the challenges facing our customers is maximizing reimbursement for prescriptions filled in a retail/LTC combo setting. A combo shop pharmacy provides services to both retail patients as well as those in the LTC community in one of the closed door settings noted above. If you are providing compliance packaging for prescriptions filled for a LTC location, then you may be eligible for our ComboMed™ service. By signing-up for this program, GeriMed can help you quickly improve your bottom line in as little as 30 days! By using the ComboMed™ program, you will be eligible to take advantage of GeriMed’s LTC network and many of the other purchasing / GPO services we provide to our closed door customers, outlined below.
GSO Services and Resources We Provide…
The GeriMed Program and Resources
Through long-term partnerships in the healthcare industry, GeriMed provides access to cost effective solutions which support our clients’ effort to improve their strategic position, financial performance, and quality of care. By using GeriMed, our customers have access to:
- Full line of brand and generic pharmaceutical contracts for long-term care closed door pharmacies, and full line of generic pharmaceutical contracts for ComboMed™ pharmacies
(limited brand contracts)
- Reimbursement network developed for maximum long-term care reimbursement with all the major contracted Medicare Part D insurance plans
- State-of-the-art consulting software – GeriMed Profiles™, with tools and reports to meet the needs of consultant pharmacists and the patients and facilities they serve
- Complete line of non-pharmaceutical contracts including automation, packaging, medical supplies, IV supplies, and many other business essentials
- Online access to members-only reports, insurance plan information, and contract information
- Software programs developed specifically for GeriMed members, detailing both contracting and Medicare Part D formularies
- e-blasts on critical changes in contracts as they occur, and weekly newsletters on information vital to reimbursement and billing
- Annual business seminar for members with timely information regarding long-term care pharmacy, reimbursement, and pertinent issues affecting the long-term care business
- Corporate partnerships with NCPA, ASCP, and other industry affiliations
- GeriMed management participates in meetings at NCPDP, CMS, and with members of Congress to ensure the interests of long-term care pharmacies are fairly represented
- A dedicated sales and account management team to ensure our members have direct access and alignment with GeriMed leadership and resources
Contracting for Medicare Part-D and Commercial Plans in the LTC Space
The GeriMed LTC Network was formed over 10 years ago with an emphasis on Medicare Part D LTC reimbursement to better assist LTC and combo pharmacies in their operations and contracting with PBM’s and health plans. GeriMed understands the growing pressures on pharmacies and is dedicated to working with the payers to create synergies as well as create a winning strategy for pharmacies to succeed. These payer relationships along with our winning strategy have enabled GeriMed to develop enhanced programs for our pharmacies, such as competitive reimbursement rates, MAC issue resolution, customer service support, and many other programs, while staying on the cutting edge of technology. The list below is a sample of Medicare plans and PBMs for which GeriMed is contracted:
- Caremark (including Aetna & Silverscript)
- Express Scripts (including Medco)
- Envision Rx Options
- Optum Rx (including Catamaran, Cigna and Health Spring)
- Prime Therapeutics
Through our user-friendly and members-only website portal, GeriMed customers have access to a suite of timely and actionable reporting – at no additional cost. A few benefits of our reporting package include:
- Purchasing reports generated monthly to ensure proper attachment to contract pricing
- Missed opportunity reports to demonstrate the best generic product pricing versus purchased items
- Forecasting of data to maximize rebates and opportunities to increase manufacturer incentives
- Rebate tracking of historical rebate dollars and market share
- Contract audit analysis on Medicare Part D claims
835/EOB Remittance Advice Management
Health plans must provide a remittance advice which identifies all claims paid within a cycle and corresponds to pharmacy payment. The electronic remittance advice is called an “835”. GeriMed will work on behalf of pharmacies to retrieve the 835 from the health plans and make them available to
pharmacies on a secure FTP site. Pharmacies may then access all 835s, from one location, for the health plans they submit claims to for payment. There is no fee or additional costs for using this service which includes:
- Secure FTP site
- One location for all 835s
- 835 support
- Software to locate 835s
Audit Compliance and Resolution
One of our most popular services that we provide our member pharmacies at no additional cost is the GeriMed Audit Compliance and Resolution service. This team has a proven track record in preventing PBM audit recovery of legitimate payment on valid pharmacy claims. Additionally, GeriMed has a proven success record in restoring valid payments that have been taken by the payer after a final determination of an audit. Our Audit Defense Services include:
- Documentation Review
- Audit Manual Template
- Appeal To Payers
- Staff Training
- Regulatory Research
As your partner and advocate, GeriMed is pleased to offer our member pharmacies another value-added service – the ability to dispute MAC claims at no additional cost. Should you have a MAC issue, all you need to do is complete the MAC Price Inquiry Form link on our website and submit the requested information along with a copy of the purchase invoice of the drug(s). Once the form is submitted, you will receive an e-mail response indicating that GeriMed has received your inquiry and the claim will be researched in a timely manner.
Medicare Part D Formulary Management Software
GeriMed has made available a software program that allows GeriMed member pharmacies the ability navigate the products on formulary with each of the Medicare Part D PDP and MA-PD plans, at no additional cost. With this program, members can see which drugs are on formulary and what drugs are in the same therapeutic class within the formulary. The program also provides pharmacies the opportunity to enter medications from a patient’s profile to determine which plan may be the best for the patient from a coverage standpoint.
Weekly PBM Updates
GeriMed is dedicated to providing our pharmacy members with timely and relevant information which results in operational and financial success. The Weekly Dose is used to communicate Medicare Part D plan information, CMS requirements and news, Contract Rates and Obligations, and LTC industry information. Each week, the Weekly Dose is e-mailed to pharmacy owners, management personnel, billing staff, and designated pharmacists. As a member of the GeriMed LTC Network, pharmacies will automatically be signed-up to receive this valuable publication.
Pre and Post Editing
Through one of our valued corporate partnerships, GeriMed works with Veridikal to offer member pharmacies Pre and Post edits that provide real-time guidance that drives compliance, reimbursement, and performance at the point-of-sale. Veridikal also provides detailed analytic reporting to ensure the pharmacy is maximizing reimbursement on every claim. By using this service, pharmacies will have access to integrated reporting, analysis, and monitoring via a reporting dashboard that enables you to analyze the data stored across your enterprise to make better business decisions. Some of the benefits of Veridikal:
- Helps ensure maximum reimbursement is obtained on every claim adjudicated
- Reduces claim submission errors and resubmissions
- Improves automation, decision making, and productivity of the pharmacy
- Audit protection program that identifies specific areas of exposure to drive compliance and reduce potential ‘take backs’ from payers
- Provides tools and reporting to enable concise decisions to improve business and margins
FDS eConcile Complete® is a comprehensive, cost-effective solution for GeriMed member pharmacies to quickly manage third-party receivables at the claim level. There is no software to install or maintain. eConcile reports provide detailed financial insight into the third-party receivables process. With this service, the pharmacy simply verifies receipt of payments and FDS handles the remaining reconciliation processes.
- FDS collects claims data and electronic remittance advice (835 files) from GeriMed/PBM’s to load into eConcile®
- FDS will upload any paper remittances received
- Customer verifies all third-party payments received along with EFT confirmation
- FDS matches the posted payments to the prescription claims and highlights discrepancies once the claim is reconciled
- Detailed reports are provided for review
As the industry changes, GeriMed offers reliable, comprehensive consulting software for clinical pharmacists. Our software provides access to everything from medication regimens, pharmacy billing software, to an extensive list of existing recommendations; including unnecessary drug recommendations. GeriMed Profiles™ provides our pharmacies quick, comprehensive, and easy-to-use software with real-time solutions when you need them the most. Some of the unique benefits include:
- Patient assessments
- Complete Medication Regimen Review (MRR)
- CMS Indicators and Flags
- Clinical Tools
- Dosing Modules
- Drug Interactions
For over 30 years, GeriMed has been supporting independent pharmacies servicing long-term care and home care patients. We are honored you have chosen us as your trusted partner and advisor to provide you with the extensive GSO products and services outlined above. If you should have any questions about how these products work for you or if you’d like to discuss implementing any aspect of our service you may not be fully utilizing, please do not hesitate to call us toll-free at 1-800-456-4374. If you are considering a change to GeriMed, we also welcome you to explore our products and services by visiting our website at gerimed.wpengine.com, or by calling us at the same toll-free number, 1-800-456-4374 and asking for a representative of our sales team.
GeriMed is the service you can depend on for those who depend on you!