A DME Billing Q&A with Newhard Pharmacy

This family pharmacy has offered a full line of DME for longer than 40 years — and sharpened its billing in the process.

• By Joseph Duffy
• Jun 01, 2016

Newhard Pharmacy has been owned by the Pavis family since 1969. In 1975, they started offering a full line of DME products, excluding oxygen. In 2015, John Pavis, president of Newhard Pharmacy, bought out his father’s share of the business and has been leading the charge ever since. Here is how Newhard has handled its DME billing.

HME: When you first started selling DME products, what were some of your billing challenges?

John Pavis: Initially, we hired a third-party billing company to get it started on the right foot. With DME, the terminology and requirements are very different from typical pharmacy claims. It is intimidating at first but once you start to understand how the systems operate, it gets easier. In the early 2000s, we felt confident enough with our staff to bring all the billing in house.

Did you use your pharmacy billing system or integrate a new system?

We evaluated several systems and decided to purchase SystemOne, offered by our pharmacy software provider, QS/1. We feel that staying with QS/1 helps streamline the challenges of electronic billing.

What are some of the DME billing issues/challenges unique to pharmacies?

Documentation! We are the liaison between the patient and their physician, providing education and service to both. We support the physician’s desire to provide the patient an effective, cost-efficient product that improves their quality of life. To do this, we must have the proper documentation for dispensing. Additionally, we need to support the patient’s use of the products and help monitor their adherence to the doctor’s orders. The patient must trust that we are properly charging their insurance and are paying as little as possible out of pocket.

How did you overcome these challenges?

We work on it daily. We have created different checklists for documentation required for each DME product. These ‘cheat sheets’ help employees know what to ask for each DME product as the requirements are drastically different.

What is your current pharmacy/DME billing solution and how has it been working for you?

We have stayed with QS/1’s SystemOne and have supplemented it with Zirmed. This additional system of pre and post edits helps ensure that mistakes are caught upfront, which helps us get paid faster. We feel adding this extra help gives us the best chance to get paid correctly the first time. Second and third submissions cost time and money.

Regarding billing practices, what are your top tips for pharmacies looking to sell DME products?

‘Keep Trying’ is our mantra. There is a way to be successful in HME billing, and many companies are doing it. When we hit a roadblock, we try again a different way. We also ask a lot of questions. We raise questions all along the way to our vendors, our software providers, the insurance companies, our accreditation organization and other HME business owners about any situation that we don’t understand why we aren’t getting paid or getting paid enough. We’ve learned a lot along the way and despite all the challenges, we are still committed to growing our DME business. We try to attend all available conferences to continue our education as DME is changing all the time.

This article originally appeared in the DME Pharmacy June 2016 issue of HME Business.