Pharmacy Billing &
Revenue Cycle

Defending Pharmacy Margins in a Volatile Landscape.

The pharmacy business model is under siege

DIR fees are climbing. PBM clawbacks are relentless. Reimbursement rates are shrinking. For LTC pharmacies and Home Infusion providers, the margin between profitability and loss is razor-thin. Zenexa defends pharmacy economics with specialized billing logic, per diem optimization, and proactive PBM dispute management.

Specialized Solutions: LTC and Home Infusion

Per Diem vs. Itemized Optimization

Our analysts determine the most profitable billing method for each patient encounter—switching between per diem and itemized as census and acuity change.

Census Matrix Management

Real-time census tracking across facilities ensures billing accuracy and prevents revenue loss from missed admissions or discharges.

Speed of Prior Authorization

Automated PA workflows with payer-specific turn-time tracking. We escalate delayed PAs before they become missed doses.

Fighting PBM Tactics

We build audit-ready documentation packages and dispute templates for DIR fee challenges, MAC appeals, and clawback reversals.

Revenue Protection

DIR Fee Mitigation

Proactive analysis of DIR fee exposure with dispute strategies. We challenge unfair retroactive adjustments with documented evidence.

Inventory Cash Flow

Billing velocity optimization to minimize days in A/R and improve inventory cash conversion cycles for high-cost specialty drugs.