Top Challenges for Pharmacies

May 25, 2016

Top Challenges for Pharmacies

Challenges for Pharmacies are no less and they greatly affect the revenue flow, having more losses. With changes in healthcare and increasing demands, Pharmacies too are facing the brunt. Various barriers are keeping them from maintaining smooth revenue. Billing challenges significantly affect the bottom line, although a host of other challenges exist that can affect Pharmacy reimbursement. The primary focus of pharmacies should be patient care. There are many mandates that keep the pharmacies from doing so.

Here are some of the top billing challenges that pharmacies encounter:

  1. The roles and responsibilities of the pharmacy staff may not be identified properly during billing.
  2. Pharmacists may not adequately document codes for drugs while billing.
  3. The staff may not have the resources for updated information and training about various drugs and their codes.
  4. Information about allergies caused by various drugs may be missing from the system. This could lead to poor customer service.
  5. The staff may not be aware of maximum dosage requirements of the drugs.
  6. The billing system may not be updated with the latest government rules and codes for various drugs.
  7. Only a certain set of drugs, injections and therapies may be covered by insurance. Experts may need to assess if it is worth including or excluding them during billing.
  8. Low quality of customer services could result in poor customer relations.
  9. The pharmacy’s billing system may not flexible.
  10. Medical billing may not process vaccine claims covered by pharmacy or medical benefits.
  11. Claim denials could be frequent because of missing information, lack of updated drug codes, or missing medical records.
  12. Incorrect payments could occur because of error in submission of data. This in-turn could affect revenues and budget planning.
  13. Incorrect Charge Description Master (CDM) could result in underpayment, claims denials and fines.
  14. The pharmacy’s billing system may not be scalable.
  15. Shortage of work force could lead to wasteful utilization of time and energy during billing, especially when critical cases need to be handled.
  16. Access to patient’s eligibility at the time of service may be unavailable.

To work seamlessly, here are some best billing practices that need to be followed:

  1. Centralized IT systems could minimize duplication of work and errors during billing.
  2. Updated information about government rules and regulations and drug codes, should be incorporated in the billing system.
  3. Inventory management should be integrated with the billing system.
  4. The billing system should be automated and should have all the details of the patient.
  5. Regular training should be provided to the staff.
  6. Billing systems should be flexible and scalable.
  7. The staff should be given proper roles and responsibilities.
  8. Right information should be provided while giving service to the patient. Only then billing could be done in a timely manner which could reduce claim denials.

End to end business solutions should be provided by the billing system to ensure client satisfaction. These best practices should be incorporated by all pharmacies when providing service which will ultimately help in improving the revenue cycle process, bringing in appropriate reimbursements and retaining a healthy flow of uninterrupted revenue.


Category : Practice Administration