Are Your Pharmacy Billing Collections Below The Expectations?

Most large medical practices often offer in-house pharmacy services. But while you are offering the service for the convenience of the patient, doctors, and health staff, it is quite natural that your pharmacy billing collections is below the expectation.

Several factors can lead to revenue loss regarding pharmacy billing services. But with so many effective medicines and pharmaceutical companies in the market, if you are losing revenue due to faulty billing, it will impact your organization. The revenue loss will result in low productivity of the facility, but it also loses focus on the patients by failing to give them the proper care.

This article will discuss five causes that can challenge the revenue collection in pharmacy billing and ways to overcome the low collection.

Top 5 Challenges in Pharmacy Billing Collections

There are quite a few reasons for your facility failing to make the optimum revenue collection in pharmacy billing. Some of them can be due to the issues discussed below.

1. Payment Posting Error

There can be several ways that a payment posting error can occur. First, staff can make a mistake with entering the correct data. The tool or software you are using is making an incorrect A/R calculation. These will impact the revenue collection and result in poor budgeting, forecasting, and planning for the facility.

2. Lack of staff

When it comes to pharmacy billing within a medical practice, you require a team dedicated to this category for revenue collection. This is because the staff has to hand over the medicines to the patients and caregivers while being skilled to process the billing quickly, so the patients don't have to wait for long. Hence it would help if you had enough trained staff to handle the pharmacy medical billing and coding services.

3. Untrained staff

Often pharmacy claims are denied due to the wrong coding and limited information. Your staff must be trained and knowledgeable about the latest medicines to write exact codes for the claims. The claim will be denied unless up-to-date information on the drug and the related treatments are provided.

4. Repeated denials

The failure to keep the patient files and information updated and the lack of knowledge about the drugs and codes eventually results in wrong coding and billing. All of these lead to repeated denials, mainly if the reason for the rejection is not addressed immediately. It hence leads to severe revenue loss for the practice.

5. Checking insurance coverage

The staff must check if a patient's insurance policy covers the medical bill to ensure that the pharmacy medical billing is done correctly. Failure to check the eligibility will lead to claim denial and reduce patient satisfaction, hence increasing the churn. In addition, it will eventually impact the revenue of the facility.

While all these five challenges can leak into your pharmacy medical billing revenue, there are ways to mitigate them.

Top 5 Ways to Overcome Pharmacy Medical Billing Challenges

With most pharmacies having transformed into providers of healthcare by dispensing over-the-counter medicines, the setting depends on the state's regulation, where direct medical billing for patients can be provided. Though there are other ways to reimburse for the pharmacy billing, new delivery models based on care are witnessing an improvement in the revenue cycle management for the pharmacy setting.

In such a scenario, it is worthwhile to note five ways to improve their revenue while reducing the denials and rejections of the claims.

1. Automate the system

There are many software and technological tool that helps with automating the system. However, mainly when refilling the medication, the automated process can prevent fraud and abuse of medicine duplication. Also, it helps in freeing the staff to do other pressing jobs than the repetitive work, thus saving time and money.

2. Workflow management

When your pharmacy business is scaling, it is time to re-evaluate the staffing requirement and incorporate the necessary technology. Experts should be hired to check whether your pharmacy is equipped to meet the new challenges, like handling inpatient, outpatient, or community. Workflows must be handed and delegated to different teams for a seamless process. Only when you can manage the workflow can the inflow of patients be handled quickly, eventually increasing revenue.

3. Knowing the coding rules

Efficiency in coding is of utmost importance for successful pharmacy billing. Often pharmacists use CPT codes for reimbursing the services. They also used the JW modifier at the time, but one needs to be aware that it cannot be used on drugs or biological claims for services offered under CAP. Hence, it is essential that before filing the claim, the rules and regulations are known and checked with the state Medicate contractors. Moreover, checklist codes must be updated regularly, and there is an expert to inspect the errors made.

4. Correct documentation

Putting a correct documentation process in place can help prevent fraud and claim denials. A pragmatic partial-fill protocol must be implemented to avoid accusations of partially filling prescriptions to generate the dispensing fee. Also another way to ensure the correct documentation process is followed is by introducing regular internal audits. The process goes a long way in increasing the revenue by keeping the mistakes in check.

5. Encourage collaborative protocols

The scope of collaboration between pharmacists and physicians is minimal. Furthermore, with each state and disease, the collaborative protocols' setting changes and the Medicaid program varies between states too. In such a scenario, it is essential to know the CMS rules and regulations and the patient's coverage so that the right claims for the reimbursements can be made.

How to Manage All These Factors?

You need to bring in an expert to your pharmacy house to navigate the protocols. They can quickly implement the latest software and technology. A team of 24/7 Medical Billing Services has a dedicated and experienced staff who are aware of the different coding while managing the workflow. Outsourcing pharmacy medical billing to them can help you make the optimum collection of your revenue to serve your patients better.

Read more: Medical Billing For Prescription Drugs – Pharmacy Billing Made Easy