What is Your Next Generation Revenue Management Strategies for Pharmacy Billing?

Pharmacy billing strategies

With traditional fee-for-service programs giving way to value- and population-oriented strategies, it is forcing health organizations to offer quality care at affordable prices. As a result, health systems have been undergoing large-scale transformation to reduce costs and improve quality of care. Today all medical stakeholders need to increase their operational efficiency as well as quality of services delivered while remaining profitable.

A pharmacist is the first customer touch point in the local health resource center. Not only do they perform the primary duty of dispensing medicines but are now emerging as health professionals who promote medical adherence and advise on a patient’s wellbeing and disease management along with daily disruptions of pharmacy operations.

As a result, pharmacies are now considering new revenue management strategies to improve overall operational efficiency, ensuring stringent quality and maintaining healthy bottom-lines.

Replacing manual activities with automated: The core activity of any pharmacy is drug dispensing. Any automation introduced here may result in significant time saving allowing the management to focus on critical activities. Similarly, Billing is an important everyday function that requires precision. Any automation in this process will be very beneficial for the pharmacists. That is why; pharmacy billing solutions receive the unwavering attention of pharmacists across the globe. Outsourcing pharmacy billing services to pharmacy billing providers will reduce the time consumed in documentation, report generation and other data management tasks.

Improving Profitability Scores:  Leakages in revenue cycle can be minimized by tracking payments to closure and monitoring for discrepancies. Pharmacies can display robust financial health by outsourcing pharmacy services to a pharmacy billing specialist or a pharmacy outsourcing company. With the experience and efficiency in accounting mechanisms, these providers minimize the claims rejection cases by performing mandatory data validations on the claims request form.

Keeping the medication cost low: Pharmacies may negotiate contracts related to reduced transaction fee on each billing request with PBMs (Pharmacy Benefit Managers) and also check with the manufacturer for discounts on high volume purchase of generic and branded drugs and their mail order pricing.

Mail Order Servicing: Mail Order services tie up with a patient’s insurance plan. Registered members can receive the maximum medication supply as per their plan and round-the-clock access to pharmacist advice. Patients can add members; track their order status and set up auto refill process. Medicines are conveniently delivered to the doorstep.

Such Mail order pharmacies minimize operational costs by eliminating the need for investment in real estate stores and free of cost shipping helping improve customer satisfaction and savings. By optimizing the pharmacy services and increasing the time spent by a pharmacist with a patient, pharmacies can increase the overall sales opportunities.

The Road Ahead

With a goal of enhancing customer convenience while ensuring quality care at optimized costs, pharmacies can either transform operations for improved outcomes or outsource pharmacy services to a service provider.

As digital connectivity empowers customers, the focus on customer-centric operations will grow steadily, offering additional scope to future-proof operations. With constant digital innovations, medication instructions and communication will be delivered across multiple digital channels.  As a result, Pharmacists need to adopt a proactive stance to deliver personalized care in quick and accurate delivery cycles.

Apart from efficiency, quality, and profitability being the levers of change today, pharmacies need to constantly reinvent their business models and strategies to ensure sustained competitive differentiation.

Adopting an overall pharmacy billing management solutions targeting pharmacy’s intake registration, insurance eligibility, preauthorization checks, drug codes, payment posting, census maintenance and Medicare pharmacy claim status checks etc does minimize rejections and increase compliance for the pharmacy.