Importance of Accurate & Ethical Pharmacy Billing

Pharmacies practice their specialized clinical and advanced training that allows them to evaluate, monitor and adjust drug therapy while working in close collaborations with physicians and patients. Clinical services like medication monitoring, adjusting doses and regimens, and sometimes even changing prescriptions are some of the important functions that a pharmacist is trusted with on the […]

Effective use of J-codes In Pharmacy Billing

Healthcare Common Procedure Coding System (HCPCS) is based on the Current Procedural Terminology (CPT) developed by the Center of Medicare and Medicaid (CMS). Till 1996, HCPCS was optional but after the passage of the Health Information Portability and Accountability Act (HIPAA), the government had made the use of HCPCS mandatory in certain cases. The HCPCS […]

Pharmacy Billing In-house vs Outsource

A pharmacist is constantly striving to ascertain between different drugs and patients. They juggle between rules, regulations and learning in the modern health care industry. The job just became more compounded with the pharmacy claim process. Pharmacy billing has come to the forefront with increased regulations on the drugs prescribed and sold. The rules and […]

Strong Prior Authorization for Affordable Pharmacy Billing

Prior authorization (PA) requires a pharmacy to obtain approval from your health insurer to dispense a specific medication prescribed by the doctor to you. The PA clause is usually put to use in case for very expensive medication. The adoption of PA technique is known to minimize health care costs, as the benefits are only […]

Why are Pharmacy Billing Specialist Important for Maximizing Revenue?

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 […]

Common Pharmacy Reimbursement Strategies to Calculate Insurance Payments

The current fee-for-service reimbursement model places the incentives on volume over value, lacking any scope for preventive care and care coordination among providers. In order to lower down the cost and improve medical outcome the payment structures need to be redesigned to focus incentives on results and overall value of healthcare. Here are some research […]

Save 9% On Medicare Payments By Reporting PQRS

Quality measurements and quality data reporting are an integral part of Medicare programs. PQRS (Physician Quality Reporting System) is one such reporting that is to be demonstrated to meet the quality performance standards. PQRS is a quality reporting program that boosts group practices and individual EPs (eligible professionals) to report about quality care to Medicare. […]

How Will the Change From Fee-for-Service to Value-based Care Affect the Revenue Cycle?

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 […]

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 […]