Pharmacy Billing Services – In house v/s Outsourcing

As per the Drug trend report, the traditional biotech drug that lacks generic competition has been experiencing a continual increase in price. Furthermore, the CMS has reduced the Average Sales Price (ASP) margin from 6% to 4%. All these changes are going to affect the pharmacy reimbursement rate as a consequence. However, there are certainly more aspects due to which pharmaceutics are experiencing their revenues hitting the wall.

Although pharmacists work at large integrated health systems and primary care centers, their reimbursement rate declines with every additional case. This happens mainly because there is always a pile-up of outstanding accounts receivables. Therefore, if the pharmacy billing process is not organized properly, it will only result in a negative financial burden.

No one likes to lose money that they genuinely deserve. As a pharmacist, if the billing process is slowly becoming a nightmare for you, outsourcing is the answer. It is a smart choice that can provide you with a peaceful sleep at night.

The first and foremost thing you need for your pharmacy billing is the best billing and coding practices. Whether you seek to outsource your billing or get it done in-house, the effectiveness of your pharmacy billing begins and ends with the right and appropriate knowledge of the coding and billing.

What will be the Impact if you chose In-house Pharmacy Billing Services?

Pros: There are some advantages of having an in-house billing team for your pharmacy services as:

State-by-State Regulations:

As per the Medicare Part D program, the Medicare prescription drug plans require compliance with specific state laws to submit prescription claims. In order to enhance the reimbursement amount, the medical groups and other substantial practices generally opt for an in-house pharmacy billing process as it is regulated on a state-by-state basis. However, make sure that the in-house billing team should be properly trained and certified with the latest regulations so that they can handle the different drug coding categories smoothly.

Higher ROI- Return on Investment:

The practical and efficient handling of Pharmacy Billing offers numerous opportunities to your practice to improve the overall bottom line of your business. This is possible only after investing in training to your in-house billers and coders and purchase updated billing software and technology to smooth the billing operations. Undoubtedly, it means a loss of a lot of time and money, but it is worth investing. Therefore, if you have the necessary infrastructure, latest billing software, and trained employees to handle the pharmacy billing system, you can just focus on refining the existing billing processes to generate the best ROI for your practice.

Cons: There arecertain issues that can create a bottleneck for your pharmacy billing process, especially when it is in-house as:

Internal Theft:

Internal theft is one of the biggest challenges faced by businesses for relying on the in-house team. As per the estimate of the US Department of Commerce, $500 billion is lost every year due to internal business theft or carelessness. The same scenario is observed in the case of the pharmacy billing department as well. In case managers don't keep a strict check on the pharmacy billing operations, then there are high chances of going this department unnoticed with the multiplying losses.

Staffing Issues:

Is this an easy task for you to hire specialty-certified coders who are well aware of ever-increasing regulations? Can you afford such experts who can keep your practice on top of all the changes? Only a few practices have enough resources and knowledge to hire the in-house billing team. In fact, if there is a shortage of employees in your in-house pharmacy billing team, your operations – especially the cash flows can be majorly obstructed. Imagine a situation when your employee goes on a vacation or simply takes a day off; your entire billing operations will be halted for the day, thereby delaying the process considerably.

What’s Next?

If you're really looking forward to improving your medical billing and coding process, it is important to seek help from a dedicated team of billers and coders. Entrust your pharmacy billing to a reputed outsourcing medical billing team that can promptly assure you a smart and seamless billing service. They will take care of the entire revenue cycle spanning across the various domains like:

• Pre-admission procedures
• Data entry for patient’s information
• Data coding
• Generation of billing statements
• Management of accounts receivables
• Following up with the insurance payers for claims, approvals, and denials
• Hospital billing collection services
• Reporting of the collections

Moreover, the outsourcing team of billers and coders keeps updating themselves about the new regulations and developments in the field of pharmacy and healthcare.

What will be the Impact if you chose to outsource your Pharmacy Billing Services?

When you partner with a premier pharmacy business outsourcing company like us, you can enjoy certain unbeatable benefits like:

• 98% accurate billing for your pharmacy
• 50% reduction in your overall pharmacy management costs
• 99.9% uptime on document management repository
• Highly scalable services
• Multi-specialty expertise
• 24/7 web-based access
• Complete data security
• One to one service

The selection of 24/7 Medical Billing Services as a pharmacy business outsourcing partner would mean optimizing your pharmacy billing processes through reliable, timely, and uninterrupted outsourced services at the most reasonable prices.