What does a Pharmacy Billing Specialist do for Your Practice?

With increasing competition and decreasing margins, survival is becoming a challenge. As a result, to enhance the business processes and efficacy, pharmacy companies have either moved to an automated management systems or planned to outsource pharmacy services. Billing being an integral function that requires precision and agility, anything/anyone who can simplify the process could be extremely beneficial for pharmacists. Thus pharmacy billing software as well as pharmacy billing specialists receives unwavering attention of pharmacists across the globe.

Why a practice should choose hiring a Pharmacy Billing Specialist?

Delay in payments, documentation work, follow ups can put stress on any practice. So hiring a pharmacy billing specialist will:

  • Ensure that your billing is done correctly and on time
  • Provide a vast knowledge of billing regulations that includes Medicare, Medicaid and the new Affordable Care Act.
  • Provide claim processing for non-beneficiaries who have received medical services.
  • Be an expert in interpreting the medication orders, calculating and compounding the dosage, and dispensing the medications.
  • Help in submitting the correct codes and thus reduce claim denials
  • Ensure compliance of billing system to the ever changing billing regulations.

This means that your practice can run smoothly without any disruption of late or overdue payments.

How a Pharmacy Billing Specialist help your practice?

From patient authentication to payments, a pharmacy billing specialist will take care of the entire revenue management for pharmacy billing from start to end.

  • Details of the patient: This is the first and the most important step of any billing process. Capturing details such as medical reports, prescriptions, doctor, medical history, drugs etc. accurately is very necessary and yet tiresome task.
  • Documentation: If a customer makes a medical claim, it needs to be documented properly with doctor’s details, diagnosis, treatment, reports, patient discharges etc. An accurate record will help in faster medical claims. Apart from that, a pharmacy billing specialist can also define your processes in detail for different drug categories comprehensively
  • Codes and Drug Categories: A pharmacy billing specialist is trained to handle various drug code categories (CPT) and is well versed with any coding guidelines and emergency codes. They ensure
  • The authorizations are acquired before any bills are processed thus minimizing the claim denials of patients with health plans.
  • Follow ups: A billing specialist ensures that each and every service that is delivered is recorded and billed accurately. Following up with the patients and vendors ensure that the payments are received on time.
  • Fewer Rejections: With thorough knowledge of healthcare billing processes for various branded/non-branded drugs and A-rated generic drugs, a billing specialist can minimize rejections.
  • Report Generation: A specialist can play with numbers and offer statistical/analytical reports to help in faster decision making.
  • Refill Management: With a specialist’s assistance, one can process refills immediately and may also send timely reminders to your repeat customers for refills.
  • Cost of pharmacy services: A pharmacy billing specialist can also help in reducing and maintaining the cost of pharmacy’s services. They help in increasing the overall financial operating margin by purchasing drugs at reduced prices due to volume discounting, reducing drug pilferage, improving billing accuracy, improving the drug formulary system and by implementing drug inventory management procedures that have been tested.
  • Improve the overall pharmaceutical care: They can also help in improving the overall pharmaceutical care provided to patients as well as support provided to medical and nursing staff.

Apart from helping you increase your productivity as well as quality levels, outsourcing pharmacy billing services to a pharmacy billing specialist will help in expertly managing everything from payment posting to patient verification making pharmacy billing the easiest chore for you.