Medical Billing for Prescription Drugs - Pharmacy Billing made Easy

Due to the sheer complex procedures required to make the bills accurate and compliant, pharmacists were never at easiness with pharmacy billing requirements. The problem has been exacerbated over time by recent trends of declining reimbursements and rising DIR fees. To counteract the dual impact, pharmacists are now providing clinical care to patients. In the process, they have added another problem to their list, i.e., billing in lockstep for a service that is vastly different from pharmacy medical billing.

Unlike hospitals and clinics that have full-time billers and coders to deal with billing and coding issues, pharmacies have to bill without the assistance of these dedicated experts. Furthermore, billing for clinical care is a detailed and time-consuming task that pharmacies cannot afford to spare.

In such a scenario, the only and simple solution for pharmacies is outsourcing pharmacy billing services to an experienced pharmacy billing company. These providers have pharmacy billing staffs that are well-trained and experienced in dealing with the complexities of pharmacy and clinical bills.

How does an Outsourcing Pharmacy Billing make the Journey Easy?

Outsourcing assists pharmacies in overcoming a variety of pharmacy medical billing problems. However, the following are some common pharmacy billing issues that an outsourced pharmacy partner can easily resolve:

The Audit Specter:

Undoubtedly, if there are too many errors in your pharmacy medical billing, the auditor’s team will definitely come knocking on your door. No matter whether it's Medicare or another payer, they won't leave any stone unturned in identifying flaws in your process once they reach your doors. In fact, if you are found guilty, you will have to face the consequences, which can range from massive fines to the cancellation of payer contracts. So, in order to keep the auditor at bay, you must have proper control over your process. Else, you may be forced to conduct regular internal audits with the assistance of third-party agencies, which will be prohibitively expensive.

A/R is Growing Older:

A/R aging is a common issue for almost all pharmacies. In fact, this is the most common practice in all infusion pharmacies. This means that when the oldest accounts are more than 90 days old, they become write-offs. And as the number of them increases, you are staring down the barrel. To make matters worse, there is no proper means or strategy in place to deal with it. As a result, when your high-dollar A/R requires concentrated attention, you lack the resources to implement a recovery strategy for the outstanding accounts.

Lack of Experienced Billers:

Another issue that pharmacies face is attrition, which forces them to hire less experienced billers. And the costs for this are frequently exorbitant. When dealing with inexperienced billers, you must deal with issues such as incorrect coding, inaccurate billing calculations, wrong modifier usage, incorrect primary payer billing, and so on. Some pharmacies believe that having a strong quality control team will help them overcome this. However, the QC team is also prone to errors because they are frequently asked to bite off more than they can chew.

Updates in the Healthcare Industry:

The healthcare industry is enacting new rules for pharmacists at a breakneck pace. By staying up to date on these rules, you can ensure that your reimbursements are always received on time. However, in order to do more with less, pharmacy billers rarely have time to stay up to date on rules. For example, not being aware of a changed drug dosage requirement can cause problems. Furthermore, your software and billing must be up to date with the most recent federal rules and codes for various drugs. Your employees will also require adequate training in order to comply with the most recent regulations.

Wrapping Up!

Pharmacies are frequently forced to deal with spills, especially when they are short on experienced personnel. This ultimately results in revenue loss and has an impact on revenue inflow. As a result, your pharmacy billing success is dependent on outsourcing, but it is also heavily dependent on the type of provider you select. Of course, experience is the most important factor. Always look for a provider who is equally knowledgeable about pharmacy and medical billing, such as 24/7 Medical Billing Services. You get the best of both worlds this way. They have extensive experience dealing with the common reimbursement issues that pharmacies face. Contact their experts right away to learn more about their experience in transforming pharmacy billing services.

Read more: 3 Reasons Why Pharmacy Billing Needs More Attention