Ensuring Successful Pharmacy Billing

Pharmacists play a major role in providing healthcare services to patients by physicians. And for all of us, these services are not a new thing. For years, pharmacists have been offering services over and above filling prescriptions from the origin of the profession. One of the developments in the pharmacy profession is, however, getting compensated for services provided, and to have successful pharmacy billing.

In addition, pharmacies have to take advantage of medical billing services to get reimbursed for providing specific care. The Centers for Medicare & Medicaid Services (CMS) recently implemented a temporary policy that allows pharmacies to pay COVID-19 tests for Medicare.

Key for a successful pharmacy billing system:

If you are thinking of offering in-office dispensing to improve your auxiliary revenue generated. There are a few things you need to know:

Be Familiar with Your State Laws

There are different laws, rules, and regulations in each state. The laws in several states have now made it possible for a pharmacist, in collaboration with doctors, to provide patients with medical services, but there are specific rules that they must follow. For instance, most states allow pharmacists, if necessary, to modify prescriptions and manage dosages and prescription regimens. They can also provide other services, including medication monitoring, but they rarely collaborate with doctors which can restrict their services to disease states and specific patients.

Electronic Eligibility Verification (EEV)

Consume less money and time by confirming that your patients have coverage before offering services to them. Electronic verification of eligibility allows you to efficiently charge claims and instantaneously get compensated for your services. No phone verification is one of the key advantages of EEV, which ensures releasing your phone lines only for interacting with your patients.

Transitional Care Management

As part of the Affordable Care Act, a new Medicare program called Transitional Care Management was introduced on January 1, 2013. This service is used for billing care management after discharging patients from a qualified nursing facility, an inpatient hospital, or an observation setting, for both doctors and qualified non-physician providers.

Pharmacists qualify as non-physician providers, and hence only some of these services are provided. However, a pharmacist would have to fulfill the “incident to” requirements in order to receive reimbursements, as well as have a licensed provider recognized by Medicare submit his or her claim.

Preventive Services Compensation

While state Medicaid program costs for providing pharmacy services vary from state to state, counseling, smoking cessation, and other preventive services are the most common service reimbursements for the 15 state providers of direct patient care medical compensation.

Medical Therapy Management CPT Codes

In non-institutional clinics and physician-based offices, specific negotiation contracts are required to allow pharmacists reimbursements for patient care services. This may involve the inclusion of CPT codes for “Medication Therapy Management” (MTM).

Alternatively, a capitated payment model or pay for performance (PfP) incentives may include pharmacist services. Billing for pharmacy services, if no specific contracts with private payers are available, will automatically switch to Medicare regulations.

Amalgamating with Technology like Pharmacy Management System

In the healthcare industry, technology is going to be a vital part. Process automation means a journey into the digital world that can save you time, money, and stress. Nonetheless, if your systems are unable to communicate with each other then you will create new obstacles in the same locations from where you were trying to eradicate them.

As you know the significance of documenting each and every encounter of your patient visit, documentation errors can impair your revenue cycle. Be sufficiently confident that the medical billing solution you choose merges with the pharmacy management system. If the billing solution fails to integrate, there may be chances that you will have to enter stuff multiple times which will increase your workload.

Understanding Incident to Billing

A pharmacist who works with a physician-based clinic but is employed elsewhere can use the physician-based clinic’s “incident-to billing” to charge for their services while adhering to Medicare’s 9 basic requirements.

The billing process for healthcare in the United States is very complicated and difficult to understand for patient care services, particularly for relatively new pharmacists who are still trying to understand how to generate revenue for patient care services.

We have a dedicated team of pharmacy billing specialists ready to assist your clinic in enhancing your pharmacy billing process through the pharmacy services of your clinic for maximum auxiliary revenue generation.

About Medical Billers and Coders

We are catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The main goal of our organization is to assist physicians looking for billers and coders.