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Pharmacy Billing Services
Prescription Drugs (outpatient) Coverage by Medicare
Medicare Part B (Medical Insurance) covers a limited number of outpatient prescription drugs under limited conditions. Usually, drugs covered under Part B are drugs which patient will get at a doctor’s office or hospital outpatient setting. The patient will pay 20% of the Medicare-approved amount for covered Part B prescription drugs that they get in a doctor’s office or pharmacy, and the Part B deductible applies. In a hospital outpatient setting, the patient will pay…
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Pharmacy Billing Services
How to bill for Compound Drugs in Pharmacy Billing?
Basics of Pharmacy Compounding Pharmacy compounding is the practice in which a licensed pharmacist combines, mixes, or alters ingredients in response to a prescription to create a medication tailored to the medical needs of an individual patient. Pharmacy compounding, if done properly, can serve an important public health need if a patient cannot be treated with an FDA-approved medication. The end product of the compounding practice is referred to as a compounded medication or compounded…
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Pharmacy Billing Services
How to reimburse correct amount for your Pharmacy?
As a pharmacist, you may think that your most difficult tasks will include helping patients and keeping track of possible contraindications between medicines. Many pharmacists say those tasks are easy compared to getting correct reimbursements. Pharmacy billing is no simple matter, although technology removes most of the headaches. Basics of Pharmacy Billing From Pharmacy to the patients hand, a prescription has numerous stages of reimbursement for not only the pharmacy but also the patient. Understanding…
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Pharmacy Billing Services
Prescription Drug Coverage through Medicare Part D
Medicare’s prescription drug benefit (Part D) is the part of Medicare that provides outpatient drug coverage. Part D is provided only through private insurance companies that have contracts with the federal government. It is never provided directly by the government, unlike Original Medicare. Plans can vary the list of prescription drugs they cover (called a formulary) and how they place drugs into different “tiers” on their formularies. The patient may have creditable drug coverage from employer…
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Pharmacy Billing Services
Why Prior Authorization Required for Prescription Drugs?
What is a Prior Authorization? Prior authorization for prescription drugs is required when the insurance company asks the patient’s physician to get specific medications approved. Prior authorization must be provided before the insurance company will provide full (or any) coverage for those medications. Health insurance companies pre-authorize medications in order to keep healthcare costs low. By ensuring that medication is medically necessary, up-to-date, as economical as possible, and isn’t being duplicated, health insurance companies can…
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