Pharmacy Billing – In house V/s Outsourcing

A pharmacist working along with a physician is the kind of teamwork visualized by the Affordable Care Act, which encourages the medical-home model. Like physicians, Pharmacists work with patients at both large integrated health systems, as well as small primary care practices.  And as a result, many pharmacists find their revenue hitting the wall due to accounts receivable rising as outstanding. A disorganized pharmacy billing process will find your financial nervous system badly affected.

Nobody likes to lose money and the same holds true for the pharmacists. If billing your pharmacy is a nightmare, then outsourcing is the answer to it. Outsourcing always seems to be a smart option for your pharmacy billing requirement.

Regardless of whether you keep your billing operations in-house or outsource them, the first thing that should concern you is the best billing and coding practices. The complete effectiveness of your pharmacy billing starts and ends with your billing and coding knowledge.

Let us take a look and some pros and cons of billing your pharmacy in-house:


Maintaining control:

Medicare prescription drug plans’ require compliance and laws that apply to the submission of prescription claims under the Medicare Part D program. Substantial practices and medical groups often opt for an in-house pharmacy, which is regulated on a state-by-state basis. Hence, the in-house billing team must be certified, trained and experienced who can expertly handle various categories of drug codes.

ROI- Return on Investment:

The efficient management of Pharmacy Billing provides opportunities to improve efficiency in handling patients and improve the bottom line of businesses. Once you have invested in training pharmacy billers and purchasing billing technology, means losing lots of time and money spent. When there’s a valid infrastructure in place, it’s worthwhile to just refine existing processes to generate the best ROI.


Billing liabilities:

The U.S. Department of Commerce estimates that $500 billion is lost to internal business theft every year. The pharmacy billing departments can go largely unnoticed if the managers don’t keep a stringent eye on the billing operations

Support Issues:

If your billing department comprises of only two or three staffers, your operations – and cash flow – can be majorly obstructed when even just one employee gets sick, goes on vacation, takes a leave of absence or quits altogether.

If you really want to know what you are getting yourself into, get immediate access to a dedicated team of billers and coders, where you can be assured accurate, smart and seamless billing service. Once you entrust your pharmacy billing process to an outsourcing medical billing firm, they will take care of the entire revenue cycle spanning across the following area:

  • Pre-admission procedures
  • Data entry of patient information during admission
  • Coding of data
  • Billing statements generation
  • Accounts receivables management
  • Interactions with insurance companies including claims follow up, approvals and denials
  • Hospital billing collection services
  • Collections reporting

Moreover, the team constantly works on updating the knowledge about the new regulations and developments in the pharmacy and healthcare industry.

What are your benefits by outsourcing pharmacy billing?

Apart from releasing your distress from the managerial and infrastructural hassles of maintaining an in-house pharmacy billing division, outsourcing can guarantee:

  • Timely billing of accounts
  • Real-time generation of billing status reports
  • Structured processes and quality control measures to ensure error-free billing
  • Increased collection ratio with a faster collection of accounts receivables (AR)
  • Increased reimbursements by over 20%
  • 60% savings on your operating costs

That is not all; they can take away the entire administrative burden off your shoulders so that you can forget tedious stuff and concentrate on serving your patients better.