Explore Our Blogs on Pharmacy Billing & Coding

Barriers to Ambulatory Care Pharmacy

Barriers to Ambulatory Care Pharmacy

Basics Ambulatory care pharmacy practice is the provision of integrated, accessible healthcare services by pharmacists who are accountable for addressing medication needs, developing sustained partnerships with patients, and practicing in the context of family and community. It involves being an integral part of an outpatient, multidisciplinary healthcare team to improve quality and patient outcomes by […]

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Prescription Drugs (outpatient) Coverage by Medicare

Prescription Drugs (outpatient) Coverage by Medicare

Medicare Part B (Medical Insurance) covers a limited number of outpatient prescription drugs under limited conditions. Usually, drugs covered under Part B are drugs that patients will get at a doctor’s office or hospital outpatient setting. The patient will pay 20% of the Medicare-approved amount for covered Part B prescription drugs that they get in […]

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How to bill for Compound Drugs in Pharmacy Billing?

How to bill for Compound Drugs in Pharmacy Billing

Basics of Pharmacy Compounding Pharmacy compounding is the practice in which a licensed pharmacist combines, mixes, or alters ingredients in response to a prescription to create a medication tailored to the medical needs of an individual patient. Pharmacy compounding, if done properly, can serve an important public health need if a patient cannot be treated […]

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Prescription Drug Coverage through Medicare Part D

Prescription Drug Coverage through Medicare Part D

Medicare’s prescription drug benefit (Part D) is the part of Medicare that provides outpatient drug coverage. Part D is provided only through private insurance companies that have contracts with the federal government. It is never provided directly by the government, unlike Original Medicare. Plans can vary the list of prescription drugs they cover (called a formulary) […]

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Why Prior Authorization Required for Prescription Drugs?

Why Prior Authorization Required for Prescription Drugs?

What is a Prior Authorization? Prior authorization for prescription drugs is required when the insurance company asks the patient’s physician to get specific medications approved. Prior authorization must be provided before the insurance company will provide full (or any) coverage for those medications. Health insurance companies pre-authorize medications in order to keep healthcare costs low. […]

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How to overcome factors impacting on pharmacy claims reimbursement?

How to overcome factors impacting on pharmacy claims reimbursement?

Healthcare service providers spend most of their time and money to achieve transparency in submitting their medical claims. But the need of the hour for specialty pharmacies is to make better practice management standards, which will allow consistent recovery of aging Accounts Receivables and stabilize the cash flow. But today, aligning your charging priorities with […]

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What every pharmacist should know about in Pharmacy billing?

What-every-pharmacist-should-know-about-in-Pharmacy-billing

As a Pharmacy specialist, you may believe that your most troublesome errands will incorporate helping patients and monitoring conceivable contraindications between prescriptions. In any case, numerous drug specialists state those errands are simple and contrasted with the one-of-a-kind bookkeeping and accounting required in a drug store. Pharmacy billing is no basic issue, in spite of […]

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Why We Need A Better Regulated Pharmacy Benefit Manager (PBM)?

Why We Need A Better Regulated Pharmacy Benefit Manager (PBM)?

Prescription drug spending is a billion-dollar problem for the payer industry. While pharmacy benefit managers (PBMs) are often a positive way for payers to manage prescription drug benefits for their members, savings for payers can be limited because of complex or one-sided contracts that benefit PBMs more than their partners. The Pharmaceutical Care Management Association […]

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Understanding The Nuances Of Pharmacy Billing

Understanding The Nuances Of Pharmacy Billing

The present day U.S. healthcare billing and coding process for patient care services is a multifaceted and difficult system for many to fully grasp. This especially vital for pharmacists who are relatively new to generating revenue for patient care services. Pharmacy billing is challenging for varied reasons, including multiple payers; distinctions of the locations where […]

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