Lisa Faast and guests Lloyd Regas from Streamcare and Josh Hardin, a pharmacy owner, discussed the benefits of direct billing for workers’ compensation prescriptions at the Pharmacy Profit Summit. They highlighted that traditional billing methods often result in low margins, while direct billing can yield significant profits. Streamcare’s service allows pharmacies to bill directly to responsible payers, bypassing PBMs, which typically keep a large portion of the margin. The process can be set up within two business days, and payments typically arrive within 90 to 120 days. Josh shared that his pharmacies saw an average of $300 to $500 per patient per month after implementing Streamcare, significantly improving profitability.
Action Items
- [ ] @Lisa Faast – If you need help determining if direct workers comp billing is viable for your pharmacy or have any other questions, feel free to contact Lloyd at lloyd@streamcare.com.
- [ ] Identify if your pharmacy has any existing workers compensation patients.
- [ ] Reach out to Streamcare to get set up for direct workers comp billing. You can get started by going to their website and filling out a 5-question form.
Outline
Introduction and Guest Introductions
- Lisa Faast introduces the session of the pharmacy profit Summit, focusing on workers comp billing.
- Josh Hardin introduces himself as a pharmacy owner from Mills Pharmacy in Birmingham, Alabama, with 13 locations.
- Lloyd Regas from Streamcare introduces himself and explains their direct billing service for work comp claims.
- Lisa Faast and Lloyd discuss the common misconception that work comp claims are unprofitable and aim to dispel this myth.
Explanation of Direct Billing
- Lloyd Regas explains the concept of direct billing and its benefits over traditional billing methods.
- He highlights that PBMs are unnecessary middlemen in work comp reimbursement, absorbing significant margins.
- Lisa Faast emphasizes the financial difference between traditional billing and direct billing, noting that direct billing can result in higher payments.
- Lloyd clarifies that direct billing does not increase costs to payers; it simply redirects payments to pharmacies.
Implementation and Timeline
- Lisa Faast asks about the timeline for implementing direct billing and its impact on profitability.
- Lloyd Regas explains that Streamcare can set up pharmacies to transmit claims within two business days.
- He notes that payments through direct billing take longer, typically within 90 to 120 days, but the higher payments offset this delay.
- Josh Hardin shares his experience with Streamcare, noting the positive impact on profitability and the ease of implementation.
Challenges and Solutions
- Josh Hardin discusses the initial challenges of identifying work comp patients and obtaining necessary information.
- He explains that once the process is set up, it becomes straightforward, with minimal employee pushback.
- Lisa Faast and Josh emphasize the importance of understanding the reasons behind the process to gain employee buy-in.
- Lloyd Regas highlights the resources and support Streamcare provides to help pharmacies through the transition.
State-Specific Considerations
- Lisa Faast and Lloyd discuss the variability of direct billing by state, depending on work comp laws and regulations.
- Lloyd explains that some states favor employees’ choice of pharmacy, making direct billing beneficial, while others favor PBMs.
- He notes that Streamcare provides guidance on which states are suitable for direct billing and which are not.
- Lisa Faast praises Streamcare’s transparency and straightforward approach to state-specific considerations.
Marketing and Support
- Josh Hardin and Lisa Faast discuss the importance of marketing to attract more work comp patients.
- Lloyd Regas explains that Streamcare provides marketing guidance and customizable templates to help pharmacies promote their direct billing services.
- He emphasizes the importance of identifying existing work comp patients and leveraging their potential profitability.
- Lisa Faast and Lloyd highlight the resources and support available to pharmacies through Streamcare, including real-time visibility portals and step-by-step guides.
Final Advice and Contact Information
- Josh Hardin advises pharmacy owners to take advantage of Streamcare’s support and resources to maximize profitability.
- He emphasizes that there is minimal risk involved, as pharmacies only pay Streamcare once claims are collected.
- Lisa Faast and Lloyd provide contact information for Streamcare and offer to assist pharmacy owners with identifying work comp patients and setting up direct billing.
- The session concludes with a reminder of the significant financial benefits of direct billing and the support available to pharmacies.