5 things about Pharmacy Billing & Re-Imbursements

Are you a physician with multiple offices? If the answer is yes, it is good to dispense medications directly from your practice. It will add to your source of additional revenue and also offer a welcome convenience to your patients.

As the healthcare sector works in an ever-changing domain, dispensing medications from your practice can prove to be a bit complicated. However, if you want to try dispensing medication as a part of your practice, you need to understand every process involved. Learning about these procedures will also help you get familiarized with various options that can simplify the dispensing medication process for you.

Let’s have a quick look at the 5 considerations about the billing and the reimbursement for dispensing medications from your pharmacy practice:

Optimal Data Workflow

It is essential to know how pharmacies balance their revenue with the expenses and bill their claims. This will help you maintain a sustainable dispensing program for your practice and keep the avenues of growth open for your pharmacy business. Moreover, ensure that the entire process is controlled and monitored, starting from procurement to inventory, storage to dispensing, and finally closing the revenue cycle with proper and accurate billing and reimbursement. All the information needed to handle the process must also be entered accurately to avoid errors that can create costly and time-consuming denials.

Compliance, Rules, and Regulations

The most volatile space in terms of standards and legalities is the healthcare sector, especially anything that involves medication. Unless you are not up-to-date with the constantly changing drug-related CMS regulations, you pose a risk of being non-compliant in your practice. This can also result in a denial of reimbursement by the payers. To avoid such a concern, pharmacies must follow the present CPT (Current Procedural Terminology) codes assigned for performing Medication Therapy Management (MTM). It is also crucial to include the NPI for both the pharmacies and the prescribers on all the claims.

Procurement

Procurement is the level where the information moves from referring to purchased quantities and the pricing for the same that denotes the storage units of measure (UoM) and the inventory costs. Mostly, the data is entered manually. In fact, the figures uploaded from the wholesale distributors to the pharmacy system are also checked manually to avoid errors. This is because the potential source of mistakes is data transfer that can impact the revenue cycle management.

Coding

Another point of attention required to eliminate the occurrence of costly errors is coding. Make sure that drugs have appropriate HCPCS coding and should be adequately represented in the chargemaster; otherwise, it will lead to no or low reimbursement. These are pharmacy charge description master, a starting point for the medical billing of payers and patients. The key is to convert the quantities of the pharmaceutical from purchased amounts to patient-monitoring quantities.

The linkage between Billing & Purchases

There are different processes in the hospitals for ordering, administrating, and reimbursement procedures for the drugs. In such a scenario, pharmacies within the hospitals are usually called upon to reconcile the links between the drug expenses and the chargemaster. But this creates a scope for improper reimbursement. Instead, having a system that can simplify the entire process of medication dispensing operation can be of great help.

Moreover, patients would find it more convenient to obtain their medications directly from their physicians. This will not only save their trip to the pharmacy but also assured them of timely handling of their queries. When you have an efficient pharmacy billing and reimbursement practice, you can make your healthcare practice more profitable and a great source of revenue.

Simplify your Practice’s Medication Dispensing with 24/7 Medical Billing Services!

Safeguarding the medication dispensing operation of your healthcare practice from all kinds of complexities is the key to your practice’s viability that can impact the revenue cycle. 24/7 Medical Billing Services can help you with a simplified medication dispensing procedure that can make your practice more efficient and effective. Don't forget to contact our experts for outsourcing pharmacy medical billing and coding activities, keeping in mind the considerations about the reimbursement.