Medical billing errors are common and are a result of various discrepancies occurring while submitting claims. These errors can prove to be extremely costly to the practice. The same is the case with pharmacies that due to numerous errors end up leaving a lot of revenue on the table. Pharmacy billing gets tedious to a large extent with billing requirements being different calling for experts to ensure smooth claim submission.
Pharmacy Billing – Blunders to Avoid
Errors in pharmacy billing are replete and it is better to be aware of the potential errors that take place to avoid them for a full reimbursement.
- Errors are in the making when medications are dispensed by the pharmacies with no billing unit standard (BUS) from the NCPDP or have applied a non-conforming NCPDP billing unit for pharmacy transactions. These can cause difficulties during reimbursement adjudication.
- Particularly common is the lack of awareness about BUS among start-ups. Although their focus could be on developing and commercializing products, they are unaware of the established protocol for billing and payment process flow.
- Despite diligence maintained by the database vendors, some products come into the market with no appropriate billing unit. At times, the same products are listed under different billing units or it so happens that their billing unit is no longer applicable because the medication is reformulated or without informing. This ends up in pharmacists overcharging or being underpaid payors.
- The biggest nightmare for pharmacists and payors is errors involving high-volume prescriptions and medication kits. This is so because it requires a lot of time and manual intervention to correct them. Both sides have to investigate and adjust payment for each affected claim.
- Dispenser confusion arising over whether to bill a product labeled as a kit as Each, Grams, or MLs results in a billing error covering kits, which are more complex to resolve.
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Billing unit errors have had a serious impact when there is an involvement of state Medicaid agencies, as overpayment or underpayment of rebates could generate a fraud investigation by the state or CMS.
Discrepancies in billing can prove highly disruptive and get time-consuming to resolve issues. Hence an understanding of the plausible errors can help avoid them.
Medical Billers and Coders (MBC) is a leading medical billing company providing complete revenue cycle management services. To learn more about complete pharmacy billing and coding services, contact us at info@medicalbillersandcoders.com/ 888-357-3226.
FAQs
1. What are the most common errors in pharmacy billing?
The most frequent errors in pharmacy billing include incorrect billing units, dispensing medications without following the billing unit standard (BUS) from the NCPDP, and using non-conforming billing units. These errors often lead to discrepancies during reimbursement, resulting in either underpayment or overpayment.
2. How do billing unit errors impact pharmacy reimbursement?
Billing unit errors can significantly affect reimbursement by causing overcharges or underpayments. For instance, billing a product under the wrong unit, such as billing in grams instead of milliliters, can lead to claim rejections or incorrect payments, which can be time-consuming to rectify.
3. Why are high-volume prescriptions and medication kits prone to billing errors?
High-volume prescriptions and medication kits are more susceptible to billing errors because they often require manual intervention and investigation. Billing these incorrectly, such as mislabeling a kit or billing the wrong unit, can lead to reimbursement delays and extensive corrective actions from both pharmacists and payers.
4. How can pharmacy billing errors lead to legal or regulatory issues?
Pharmacy billing errors, especially when involving state Medicaid agencies, can trigger legal or regulatory investigations. Overpayments or underpayments of rebates due to billing discrepancies can result in fraud investigations by state agencies or CMS, causing serious disruptions to the pharmacy’s operations.
5. How can Medical Billers and Coders (MBC) help prevent pharmacy billing errors?
Medical Billers and Coders (MBC) offers specialized pharmacy billing services that ensure accurate claim submissions by following established billing unit standards and avoiding common errors. MBC helps streamline the billing process, reduce manual intervention, and prevent revenue loss due to billing discrepancies, ensuring maximum reimbursement for pharmacies.
