How to overcome factors impacting on pharmacy claims reimbursement?

Healthcare service providers spend most of their time and money to achieve transparency in submitting their medical claims. But the need of the hour for specialty pharmacies is to make better practice management standards, which will allow consistent recovery of aging Accounts Receivables and stabilize the cash flow.

But today, aligning your charging priorities with an efficient billing organization has become a practical solution for a lot of pharmacies. Confirming great practice management with correct benefits checks and insurance verification process should be your top priority. Merchants in specialty pharmacy billing and coding services will need an effective understanding of credentialing priorities.

Here are some critical points to overcome Pharmacy Billing Reimbursement factors

Daily Census Maintenance

Maintaining the census is a very important function from a medical billing point of view, as it involves producing proper records of the patient and the payee. It also includes recording data of patient discharges, change of physicians, etc. All this is indispensable especially if your customers plan to make a medical claim.


Admission is the first and the foremost step in the medical billing and coding process and involves jotting down the details of the patients, such as name, age, blood group, medical history, diagnostic reports, and known allergies.

Prior Authorization and Management

Through our billing management systems, we make certain that complete authorizations are taken before the claim handling process begins. This safeguards that the patients are always covered by an insurance plan and there are marginal claim denials. Our authorization process handles every drug category and emergency levels.

Managing the Refills

Refill management is a new area that requires great consideration and quick actions. Your customers are not going to be very tolerant with you the second time they come. Our team at Medical Billers and Coders will help you set up all the necessary approvals and reminders so that when a patient comes in for a refill, you can process it right away without any delay.

Payment Posting

This is probably the most demanding activity in pharmacy billing. However, the good news is that we can automate it. We help you streamline the manual payment postings, automatically post the insurance payments, and also lessen the data entry time.

AR Follow-Up

As a professional medical billing and coding company, we know that every small service that doesn’t get billed impacts your bottom line directly, and this is the reason we take care of it with a lot of attention and care. The most essential aspect of this service is to make sure that only the services performed are captured and billed at the right time.

Why choose us?

Our team of certified experts includes well-qualified and experienced accounts and finance personnel, and clinical specialists who have complete working knowledge of CPT codes and changing coding guidelines:

  • Documentation for drug category review.
  • To minimize rejections we use different processes for A-rated Generic Drug, Brand Name Drug, and Non-Preferred Drug.
  • Ensure all audits are in compliance, thereby reducing the drug coding errors.
  • Producing tailor-made statistical and analytical reports for the clients.
  • Each member in our team is highly motivated and aims at providing results in the shortest span of time with supreme efficiency. They guarantee a constant increase in cash flow and consistent reduction in costs.