Insurance vs. Out-of-pocket Payment: Which Option is better for Pharmacist?

Having a pharmacy business is no easy task considering the nature of Insurance versus out-of-pocket expense that both the patient and the pharmacist have to abide by. The pharmacy benefit manager (PBM), most of the time charges their customers more than the medicine costs and pockets the leftover difference. This is where an efficient, relevant […]

Can Pharmacists Solve The Shortage Of Physicians?

Recently, there have been a lot of changes that healthcare professionals witnessed. The role of healthcare professionals has changed and it is believed that by the year 2035 the numbers of primary health care physicians who are now available and managing patients are not sufficient. And with that, the role of non-physicians health care providers […]

Medical Coding Audits and Suggestions for Billing Companies

One of the most important elements of medical revenue cycle management is adhering to accurate coding and billing processes. This includes relevant documentation of medical records, precise application of billing codes, and correctly identifying the payment responsibilities of insurers for medical services rendered. A key process to ensure correct billing and coding, to avoid rejection […]

4 Ways Medical offices can Escalate Profitability

Running a profiteering medical practice in today’s time of technical hardships and billing hassles is easier said than done. Increasing competition to make healthcare affordable for the patient and strategies like rate cuts by insurance providers make it difficult for doctors to run a successful practice. However, there are ways by which medical offices can […]

A Detailed Reimbursement Process for Medicare Pharmacy Claim

The Medicare Prescription Drug Improvement Modernization Act (MMA) of 2003 created the Medicare Part D, prescription of drug benefit program and implemented it on January 1, 2006. Pharmacy reimbursement under Part D is based on negotiated prices, which is usually based on the Average Wholesale Price (AWP) minus a percentage discount plus a dispensing fee. […]

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