In the healthcare industry Pharmacy is an integral part just like other disciplines in this field. However, it also poses certain billing and coding challenges that may often be difficult to manage internally. Also, because certain drugs are excluded from the insurance provider’s coverage where only a few injections and adjuvant therapies allowed, it may require the assistance of experts to judge the efficacy either including or excluding the drugs during billing.
To obscure the matter further, pharmacy-related reimbursements require multiple levels of data processing, handling, and follow-ups in most cases. As you all must be aware that Pharmacy is a separate set of medical service and provided from a separate facility, reimbursement claims are prepared and submitted together by hospitals or nursing homes, as they come later in the care chain and also because it forms a small part of the care services that hospital provides. This joint claim preparation and submission leads to a greater potential for inaccurate data handling and resulting in denied claims.
Even though pharmacy claims are different from hospital claims, they are still subject to the same HIPAA compliance which may be difficult to cope with during times of resubmission for being non-compliant with privacy or security norms.
To overcome these inherent pharmacy reimbursement challenges you require a series of admin and data related activities, right from verification, through claim preparation and submission that needs to be with accuracy.
We at Medical Billers and Coders would not just help you accurately discern which type of treatment comes under injectable or adjuvant therapies, but also look into and handle the entire range of your admin activities right from claim preparation and submission to post-submission follow-ups and audits in case of overpayment by the insurer, plus improving your finances and leaving you with more time to look after your core competency which is pharmacy dispensing.
Clinical, Homecare and Radiopharmacy billing services
These services often come under bundled payment module that requires handling paperwork of non-clinical nature. Our experts take care of the entire paper trail that adds up to insurance claims in a methodical manner.
Home Care Services
In this service, we cater to preparation and delivery of injectable to home-bound patients, as they are covered by Medicare Prescription Drug Improvement and Modernization and require you to prepare and maintain details and do data management, which that is not part of your core competency. We have an extensive network spread across all major states of the US and experts who are experienced in handling billing and coding activities related to home care services.
Managed Care Services
Similar to clinics, these services are frequently operated from big hospitals and nursing homes that often realize their reimbursement through the bundled payment model. This undertaking requires maintaining non-clinical paperwork and generating reports, cutting away from the time you spend on patients and exposing them to information and procedural inaccuracies which often count against their performance as being part of these establishments. Our end-to-end billing and coding services spare you the challenge of having to maintain your non-clinical paperwork letting you spend more time on drug dispensing.
This being one of the most prominent therapy services, again come under the insurance coverage of the Medicare Prescription Drug Improvement and Modernization Act and require billing and coding assistance. Our medical billing and coding team have helped many Radio drug service providers and improved their finances through efficient data handling, bill submission, and follow-ups.