The US healthcare is evolving. To generate better revenue the pharmacies need to be equipped with a better billing system.
Here are some challenges faced by pharmacies that cause billing errors and affect customer relations, revenues and reimbursements:
- Access to patient’s eligibility at the time of service may be unavailable.
- The staff may not be updated with information about various drugs, allergies, maximum dosage, billing system, rules, codes and insurance clauses.
- Claim denials due to unspecified codes put pharmacies at risk.
- An increase in turn-around time, duplication of work, work-force shortage, inefficient time and energy utilization of staff members in case of critical cases, could lead to billing errors.
- Medical billing cannot process vaccine claims covered by pharmacy or medical benefits.
- The pharmacy billing system is not scalable or flexible.
- Incorrect CDM could result in underpayment, claims denials and fines. Incorrect payments could affect revenues and budget planning.
Efficiency of the billing department is critical to patient’s health related issues. Here are some strategies that can improve the pharmacy revenue –
- The billing system needs to check for patient’s eligibility in real-time. Comprehensive record sheets of the patients should be located centrally and should be available to the right party at the right time. Updating records should be done regularly. Record duplication should be completely avoided. This will minimize errors and will ensure better reimbursements.
- The coverage of all medical claims should be processed by the billing system. Claim submission and payment processing of products should be handled by the billing system.
- Automated billing systems will reduce routine and manual work and increase turnaround time. Intervention should be required in case of complex situations.
- Billing software should be updated with all the mandatory government codes and regulations and, medical and procedure information.
- Billing system should be able to process vaccine claims in real-time. The providers of this service should know the amount for which they will be reimbursed including the co-pays and deductibles.
- All types of medical benefits should be provided by the billing system.
- Scalable systems will take the pressure off of the pharmacy’s billing staff. Investing in flexible systems can provide freedom in adjusting it to the organization’s practices.
- Effective revenue cycle can be facilitated by the billing system if it reconciles with inventory system in real-time. This will reduce charge captures, billing errors, unaccounted inventories and compliance issues.
- The CDM needs to be maintained and managed efficiently as it has details like billing units, dosage specifications and drug prescription. This data should be maintained in the billing system so that all the charges generated by the pharmacy can be tracked.
In the given environment of pressing demands, Pharmacies need to buck up in order to remain profitable. It is important to strategize workflow and ensure reduction in errors that will give rise to denials, hitting the bottom line.