Government rules and regulations, online pharmacy shopping, and competition is creating many doubts and fears among pharmacists across the US. Added to this are the margins of Revenue Cycle Management that keep reducing, and the need to automate the coding and billing, generate audit reports etc seems to loom over like a dark cloud.
Pharmacists are now no longer just dispensers of medicines across the counters and doling out consultations for free. Pharmacists are now regarded as providers, and changes in the laws especially Medical Management Therapy coupled with various new laws, has now led to helping increase their revenue streams. Collaboration Pharmacy practice(not all states have a uniform practice for pharmacies) and Accountable care Organizations have given that added impetus to helping pharmacists improve their revenues, albeit via Medicare and certain Insurance vendors only. All these are positive signs for pharmacists, but can also create major administrative load on the pharmacists. Juggling the interactive networks and patients can lead to revenue being missed out, along with the added competition of online pharmacy shopping. More ever, those involved in Specialty pharmacy, have an even harder time wherein the basic requirements like flexible scalable IT platform that includes an Rx Dispensing system, a workflow manager, and a data warehouse with robust internal and external reporting ability.
Only with complete knowledge about the Revenue Cycle Management process that includes coding and billing and claim submissions can any business, even in the medical field which is now seen as a business, help increase their revenue streams. In-depth knowledge with respect to the below is an essential:
• The CPT codes and appropriate coding guidelines.
• Best practices when coding and billing.
• Best practices for Documentation for new drug category review.
• Knowledge about the different processes for A-rated Generic Drug or Brand Name Drugs.
• Dealing with claim rejections.
• Awareness of the required compliance audits.
Yes, it's a lot! Whether to concentrate on just selling prescriptions drugs, which in time could lead to decline in revenues given the online pharmacy shopping that patients are turning to, faster delivery of drugs to patients, etc. However, getting on board experts who handle the above and who have certified coders and teams with expertise in the process of claims will help you concentrate on the newer avenues of MTM and maximize your reimbursements. With these experts, when you outsource you save on investing in infrastructure and software upgrades for coding & billing, and the demand for new technology. Your investments can then be put to better use like employing more staff to handle patients queries, which gives that personal touch –keeping the tradition of the "friendly & caring neighborhood pharmacy" alive!