Services

Optimizing pharmaceutical services and pharmacy costs in Skilled Nursing, Continuing Care Retirement Communities, Assisted Living, Hospice, Long Term Acute Care Hospitals, and Home Health.

Post and Pre-Adjudication

Adjudication services at LTCPCMS works like a managed pharmacy program. Pre-adjudication allows opportunity for our team to provide real time management of an Rx prior to dispense and shipping to the facility. Pre-adjudication is always backed up by post-adjudication (sometimes known as Audit). This process allows us to identify when the managed pharmacy program rules have not been implemented. The program is real time constant management of your pharmacy costs including census payer management. All our adjudication is software driven. However, each patient is unique and has multiple nuances that may not be picked up on a typical software driven adjudication. Every single one of our clients receive double adjudication both software driven and manually reviewed for the biggest return and most effective analysis. We are so confident we can reduce your pharmacy spend we guarantee it. You do not pay us unless you receive 150% return on your investment in the pharmacy savings program. One low flat rate provides you with analytics, pharmacy negotiation, constant monitoring, non-covered medication assistance and authorizations, and managed care carve out billing support. Our rebate program provides a guaranteed return, formulary management, and utilization control programs.

Reporting & Analytics

Data is knowledge and knowledge is power. Our organization has been reporting, analyzing, and evaluating LTC Pharmacy for many years. We not only have robust databases we have many years of experience tracking and identifying trends in the industry. Our organization has worked and owned LTC pharmacies, worked as consultants with drug manufacturers (establishing benchmark pricing), audited pharmacy charges for long term care facilities and other organizations, and negotiated numerous times contracts on behalf of long-term care facilities. If you have a question or need more aggressive terms on your pharmacy contract our team is the team for you. We also provide daily, weekly, monthly spend analysis of pharmacy charges to assist you in managing your pharmacy dollars. Our clinical team works with our analysts to ensure that our long-term care clients are getting the right product for the best clinical outcomes for the right price. We are so confident we can reduce your pharmacy spend we guarantee it. You do not pay us unless you receive 150% return on your investment in the pharmacy savings program. One low flat rate provides you with analytics, pharmacy negotiation, constant monitoring, non-covered medication assistance and authorizations, and managed care carve out billing support. Our rebate program provides a guaranteed return, formulary management, and utilization control programs.

Clinical Hub

Your nursing staff can be overwhelmed by the many and constant requests from the pharmacy for additional information, formulary alternatives, information on specialty pharmacy requirements, and dialysis medication rules. Our team of technicians and clinicians will open and read any email, fax, or pharmacy portal message. We will review the request if possible, respond with the needed information to the pharmacy or reach out to the facility and discuss the issue in an easy to understand, no nonsense way. We will assist you in making the decisions and facilitate what is needed to ensure the right medications arrive at your facility, at the right time, and at no cost to you (if the resident has an alternate prescription drug payer available for that product). This eliminates the pressure on your nursing staff allowing them to focus on the care of your residents. We are so confident we can reduce your pharmacy spend we guarantee it. You do not pay us unless you receive 150% return on your investment in the pharmacy savings program. One low flat rate provides you with analytics, pharmacy negotiation, constant monitoring, non-covered medication assistance and authorizations, and managed care carve out billing support. Our rebate program provides a guaranteed return, formulary management, and utilization control programs.

Medical Billing

In today’s environment there are numerous requirements manage Medicaid, Medicare/Medicaid replacement plans, and Medicare replacement plans require some products to be billed on different formats. Our team is highly skilled at this process.

Pharmacy Procurement Assistance

  • Creating customized requests for proposals
  • Conducting requests for proposals
  • Evaluation of proposal responses
  • Evaluation of pharmaceutical program and costs

Assistance with Monitoring Drug Utilization and Charting

Including the Narcotic chain of custody compliance, charting, and destruction.

Health Care Recovery Audits with Pharmaceutical Targets

Formulary Rebates

Did you get the rebate that you are contracted for?

Pricing

Do your charges for pharmaceutical and pharmacy related products and services reflect the rate that was negotiated and is in your contract?

Duplicate Payments and Refill Too Soon Items

Is pharmacy controlling your utilization?

Dosing/Package Size

There is savings in the right package size for that particular length of stay and prescribed instructions. Are you capturing those savings?

Performance Guarantees

Managing your pharmacy utilization and quality is part of your contracted pharmacy’s responsibility are they meeting these goals?

Pharmaceutical Manufacturers and Payer Rebates

Our organization has worked with drug manufacturers for more than 10 years establishing pricing, assisting with meeting Federal pricing guidelines, manufacturer compliance with Federal reporting, interfacing with CMS over AMP reporting rules, as well as establishing and maintaining Federal rebate programs. LTCPCMS has been working with individual drug manufacturers longer than any other company in the industry. Our rebate program was the first post-acute care rebate program available. We offer our clients the highest rebates available in the post-acute care industry and paid timely as received from PhRMA. We guarantee against claw backs due to duplicate rebates and rebates improperly submitted to PhRMA. Our rebate program is a managed program that engages pharmacist management to support provider prescribing to ensure the resident is receiving the right product for their current condition to achieve the best health outcomes.

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