Independent + Trusted + Meaningful
“I find my work on the pharmacy engagement team especially meaningful because my brother is a small-town, independent pharmacist, and I have spent time working as a certified pharmacy technician and seeing health care issues up close.
I have seen people come in seeking help for an ailment because it’s after hours and doctor’s offices are closed, and the pharmacist, with their years of schooling and clinical experience, can provide an over-the-counter solution to give relief until the individual can see a doctor. This is even more important for the small-town, independent pharmacist helping someone who is not just a patient in the store, but also a neighbor they will see at the diner.
A small pharmacy can’t selectively choose which insurance plans to take, because not accepting a patient’s insurance means leaving them with an hour-long drive to the next closest pharmacy. I know there are drugs on which my brother takes a monetary loss just to make sure that his patients are taken care of. He will try to find a wholesaler with a better price, or file an appeal with the insurance company to receive appropriate reimbursement, but he will not let the patient go without their medication. However, because he is the only pharmacist, this time spent shopping wholesalers or appealing payments is time taken from patient care or from his family after hours.
Helping government health programs set fair and equitable rates from the start alleviates this burden. However, prices can change dramatically if there is a supply-chain issue, so also having a simple appeal process further saves time in filing when payment rates need adjustments.
All pharmacists and pharmacy technicians play a valuable role in our health care system. Pharmacists have been on the front lines during COVID, giving vaccinations as well as guidance, and several states have allowed certification of pharmacy technicians to give immunizations. Pharmacists quickly adapted their business models to provide curbside pickup or home delivery to make sure that patients could maintain their drug regimen. Helping government health programs find ways to make sure that pharmacists and technicians are properly compensated for the many services they provide helps ensure access to health care in areas that would otherwise go without.” Matt Hill, CPA, CPhT (Senior Manager, Kansas City)
Get to Know Matt
Matt has been involved in pharmacy cost of dispensing surveys and reimbursement issues for Medicaid programs in numerous states. Matt advises state Medicaid agencies in the design of an appropriate cost of dispensing survey instrument and oversees survey distribution, collection, and review. He oversees the cost of dispensing survey help desk to assist survey respondents and participates in client planning sessions, stakeholder meetings, and stakeholder education webinars. He contacts pharmacy providers to promote survey participation and answer questions about the survey process. He also reviews the pharmacy cost data reported on the survey and communicates with providers to clarify outstanding items.
Matt’s other involvement with pharmacy related projects has included the review of managed care organization and pharmacy benefit manager contracts and reimbursement, the review of reimbursement rates for physicians administered drugs, and the review and analysis of rebates and rebate systems.
He has experience with Medicaid program integrity for a variety of provider types. He performs desk reviews and on-site field audits of Medicaid providers. He reviews clinical documentation to verify that appropriate information of medical necessity is maintained and that services are documented as performed. He conducts claim re-pricing and validation to test adherence to payment policies. He prepares reports of preliminary findings including appropriate regulatory and policy citations.
Prior to joining Myers and Stauffer, Matt worked for seven years in the retail pharmacy industry as a store manager. His duties included oversight of all aspects of pharmacy operations including personnel supervision, training, retail and prescription and inventory management. He was responsible for reviewing daily cash reports and maintaining monthly store budgets. He also has six years of experience as a pharmacy technician and is currently PTCB certified. As a technician, he entered prescription data, reviewed insurance information and filled prescriptions under the direction of a pharmacist. He is experienced with pharmacy claims processing issues.
The work we do every day helps and impacts the beneficiaries of government-sponsored health and social welfare programs. Whether it’s ensuring proper stewardship of taxpayer money that funds programs, enforcing program integrity, or improving quality and service delivery, when we help our clients succeed, some of the most vulnerable and fragile populations in the nation benefit from this. We believe it and so do the millions of individuals helped by the clients we serve.