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Survey of Pharmacy Billing Best Practices

April 28, 2016

pharmacy survey

Efficiency in management of Pharmacy billing has positive outcomes in handling patients and improving the Revenue Cycle Management (RCM). Assimilating some of the best practices as learnings from other pharmacy billing services, is a great way to inculcate some best practices into one's own pharmacy billing to deliver greater benefits in the long run.

Automate systems and services:
This ensures faster & more accurate processes, and streamlines workflows that reflect in improved operational systems. Automated capabilities like refill updates, daily and weekly report generation, inventory level etc. are very essential to help monitor operations.

Instead of working in silos and all information lying in different silos, it is essential that incorporating with the central IT system helps avoid record duplication. Reduced errors ensure better reimbursements in a timely manner. Data and information regarding a patient's treatment, medication, bills processing, insurance details, etc. should always be accessible through a centralized system.

Stringent documentation:
For the above to work successfully, a detailed and complete documentation of all information and verification is very crucial to the pharmacy medical billing and coding department. Clear documentation provides for faster claims and especially during the resubmission process if and when required. Ensuring documentation is correct followed with a rigorous A/R follow up on patient's pharmacy billing to ensure reimbursements are done in a timely manner is essential to all Pharmacy billing services.

Compliance & Audit:
Given the complexity of healthcare industry and the government rules & regulations it is very essential that - the software, outsourced systems, and in-house team should be completely in the know of all regulations while providing services. Making provision for cutting edge training resources and user friendly access to all medications and procedure information, results in efficient service. A lack of information with respect to various drugs & their usage and government medically approved dosage related information is a must for every pharmacist to be updated about in their line of work. Both internal as well as external audits should be conducted regularly in terms of inventory and knowledge to better deliver effective pharmacy billing.

Inventory control:
This is the most vital of all and the best practices followed here will prove to be beneficial to the Revenue Cycle Management process. The pharmacy billing department should ensure that the inventory system of medicines be tracked on real-time basis. Also billing for the right amount of dosage rather than the entire contents, will help avoid fraud in the system, if when audited.

Working towards a proficient way of working requires not only automated systems but also the people productivity. Enhancing the productivity of employees with rewards and recognition programs towards evolving a greater efficiency of service towards patients and also control over inventory helps work towards reduced costs and effective pharmacy billing. Timely trainings and regulatory updates shared with all makes for a more effective pharmacy billing service.

Since the pharmacy billing department deals with medications and solutions to the patients' health-related problems it is very vital that best practices followed should and can help bring better efficacies to the business and thereby strive to exceed customer expectations.


Category : Best Billing and Coding Practices