Do you have creditable prescription drug coverage? It’s drug coverage that’s expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage. It could be drug coverage you get from a current or former employer or union, or from TRICARE, or the Department of Veterans Affairs. If you don’t have creditable coverage, you […]
From the pharmacy to the side of the patients, the prescription has multiple phases of reimbursement for patients as well as pharmacies. Distributing medication from your own hospital could be one of the efficient as well as an effective way for revenue generation. The health care industry has transformed unconventionally over the past few years […]
After submitting a claim from the pharmacy, it will then hit a service that routes the claims to the proper insurance company or PBM based on the identifiers. These are known as ‘switches’; examples of companies that offer switching services include RelayHealth and Emdeon. Switches usually charge a fee for every transaction, although they might […]
The most common categories of commercial payers to be aware of are employer-sponsored health plans and manufacturer vouchers. In the case of the patient with commercial coverage, by law, it is billed before Medicaid and Tricare and is almost always the primary payer. A common misunderstanding among patients with manufacturer vouchers (i.e. ‘co-pay cards’) is […]
Payers audit pharmacies because of billing history, a referral from an FWA hotline, a routine, random audit, or other reasons that might signify a potential for FWA to the payer. Often it is in the form of a desk audit, where the pharmacy will be required to fax documentation back to the payer, but can […]
Healthcare executives majorly depend on Pharmacy when it comes to increasing their revenue. Without saying it goes hand in hand. Furthermore, CMS has reduced its Average Sales price margin from 6 % to 4 % for non-pass-through. This has affected pharmacy billing and reimbursement. However, there are certainly other aspects of Pharmacy Billing that can […]
Patient communication at all levels in a healthcare system is proportionate to the increase/decrease in revenues. This is especially true in the case of patient interaction with pharmacists. In this article, we discuss the ways in which revenues can be enhanced by way of patient communication especially when there have been cases of dissatisfaction where […]
Health literacy deals with a patient’s ability to obtain and process the health information for taking their health decisions; and to imbibe this understanding in the patient, pharmacists play a major role. As this is the last interaction in the chain of healthcare before patients begin to take their medication, the pharmacists must counsel effectively. […]
Amidst cut-throat competition widespread in the medical industry and margins that have maintained a constant downward run, only a well-managed Pharmacy can maintain a sustainable existence. Pharmacy Billing Specialists with the help of automated management systems, mind-full billing techniques and procedures pursue every feasible measure to turn the business into a profiteering one. Anyone who […]
Adoption of Value-based care form of reimbursement over Fee-for-Service form sure is a giant leap forward towards quality health care. However, we can’t forget the gamut of financial challenges that plague our Revenue Cycles with this paradigm shift in policy. This turn in billing procedures allows providers to bill the whole value of care they […]