Third-party payers financial

The revenues on the monthly income statement have to be revised once reimbursements have been received from third-party payers. The reason for making adjustments is that most payers make adjustments to each claim and charge the pharmacy administrative fees. Therefore, the actual amount paid to the pharmacy for prescriptions dispensed is almost always lower than the amount indicated on the Daily Plan Payment report. If the manager fails to revise the revenues, the income statement will show artificially inflated revenue. This can have a number of adverse consequences for a pharmacy including inaccurate financial reports and higher income taxes. In other words, if the revenues are recorded from online adjudications, the pharmacy... 

Before Dr. Brouchard can begin providing these services, he wants to make sure that his program is financially feasible. To do this, he needs to explore ways to be compensated for his services. He is familiar with being compensated for durable medical equipment, so he knows the pharmacy can bill for blood glucose meters, but he has never tried to bill third-party payers or patients for other types of services. 

BMC has been in business for more than 100 years. Its financial success is due in part to strong leadership by the chief executive and a very active board of trustees. Until recently, BMC has generated enough revenue to meet operating expenses and to expand services to outlying communities. Unfortunately, in the past 3 years, dramatic decreases in investment income and reductions in reimbursement from third-party payers have almost eliminated the cash available for expansion. If the trend continues, there will be a shortage of operating capital within the next 2 years. 

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