As reimbursement complexity increases, small gaps in the revenue cycle can affect overall financial performance. Based on what we’re seeing across pharmacy operations, these are four areas worth reviewing regularly.
1. Unpaid Claims Visibility
What to review:
- Are unpaid claims being tracked and revisited consistently?
- Do you have a clear process for identifying missed payments?
Why it matters:
Untracked claims are a common source of missed revenue opportunities and can go unnoticed without structured visibility.
2. Partial Pay Identification
What to review:
- Are partial payments being isolated and reviewed?
- Do you have visibility into where reimbursement falls short of expectations?
Why it matters:
Partial payments can accumulate over time and impact margin if not consistently identified and addressed.
3. Remittance Reconciliation Completeness
What to review:
- Are all 835 files and remittances accounted for?
- Are there gaps between payments received and data captured?
Why it matters:
Incomplete remittance data can delay reconciliation and limit visibility into financial performance.
4. Exception Resolution Timing
What to review:
- How long does it take to resolve discrepancies?
- Are exceptions aging without action?
Why it matters:
Delays in resolving issues can reduce recovery opportunities and increase the likelihood of write-offs over time.
High-performing pharmacies don’t just process transactions; they regularly review, identify, and address gaps in their revenue cycle. If you’d like to walk through these areas together, your Inmar team can help you evaluate your current process and prioritize next steps.
Want to review this together? Connect with us to discuss your current approach.