Revenue Capture Method Helps To Proliferate Pharmacy Billing

Healthcare executives majorly depend on Pharmacy when it comes to increasing their revenue. Without saying it goes hand in hand. Furthermore, CMS has reduced its Average Sales price margin from 6 % to 4 % for non-pass-through. This has affected pharmacy billing and reimbursement. However, there are certainly other aspects of Pharmacy Billing that can affect reimbursement if the revenue cycle management is not well implemented.

The pharmacy department factually is one of the hospital’s greatest revenue generator centers. However, the pharmacy can also be a major contributor to revenue with little upfront investment. Consider hiring a pharmacy billing service provider which can provide support services to decrease the length of stay, manage medication through collaborative practices, and facilitate appropriate medication reimbursement.

Capturing full and appropriate reimbursement in the pharmacy is challenging. Frequent pricing changes, new drugs introduced to the market, outdated charge description masters CDM and missed charge capture can contribute to missed pharmacy revenue.

However, pharmacy also presents ample opportunity to streamline processes and enhance revenue to drive the bottom line.

Below Are Revenue Capture Methods To Proliferate Pharmacy Billing

  1. At times, data integrity is the greatest barrier to improved pharmacy revenue capture, for example, making sure bills should have the correct national drug code is critical to proper coding, charge capture, and reporting.

Other data-related challenges include incorrect coding of drugs procedure and revenue codes, incorrect multipliers determine billing units charged, and improperly reconciling pharmacy purchasing data with charge capture data.


  1. Eliminating data errors should be a top priority for pharmacy, operations, and revenue cycle leaders. Implementing an effective charge capture process by hiring a pharmacy billing management service that helps in bridging the data gaps can help improve pharmacy revenue capture. Three ways to improve data integrity are:
  • Integrate pharmacy data, including purchase history, formulary, CDM, and pricing data
  • Update CDM information
  • Establish a governance structure for ongoing review and maintenance


  1. By making a few upfront investments, health system leaders can see significant ROI in terms of increased pharmacy revenue and improved compliance. It is recommended for the organizations to invest in the following manner:
  • Using the latest technology and tools to support pharmacy, operations, and revenue cycle staff in proactively identifying and correcting issues during charge capture.
  • Linking the pharmacy medical billing service system with the organization’s billing system to streamline reconciliation and swiftly identifies and disconnects inventory and charges.
  • Creating a multidisciplinary management team of representatives from pharmacy, finance, and clinical staff to monitor and maintain processes, such as timeliness of CDM changes, effective communication plans, and quality checks for accuracy.

Final Thoughts

Today is all over mentioned and it’s very challenging that the political and regulatory environment is putting pressure on hospital finances. Health care centers, clinics, and hospitals are struggling to maintain positive operating margins amid decreasing government reimbursement, increasing drug prices, and growing drug shortages, and the rising cost of care.

As drugs account for a significant portion of hospital spending, pharmacy plays an important role in a health system’s financial performance. As such, improving pharmacy revenue capture through various revenue enhancement services like outsource pharmacy billing to a professional vendor can have an outsized effect on an organization’s bottom line.