Barriers to Ambulatory Care Pharmacy

Basics Ambulatory care pharmacy practice is the provision of integrated, accessible health care 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 […]


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Developing Fee Structure for Pharmacists

In the absence of any outside contracts with MCOs, all payers for service must be charged the same fee. This means that cash-paying customers must be charged the same fee that is billed to third-party payers. To charge the insurance companies a rate higher than the cash-paying customer may be considered fraud. It is important, […]


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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 which patient 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 reimburse correct amount for your Pharmacy?

As a pharmacist, you may think that your most difficult tasks will include helping patients and keeping track of possible contraindications between medicines. Many pharmacists say those tasks are easy compared to getting correct reimbursements. Pharmacy billing is no simple matter, although technology removes most of the headaches. Basics of Pharmacy Billing From Pharmacy to […]


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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?

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?

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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How does a RCM Pharmacy manager can benefit and impact the ecosystem?

Drug therapy, compared to hospital treatment and the surgical procedure is more coherent of medical treatments. Who’s in charge of prescription benefits? Many people think that prescription drug aids come straight from a health insurance provider, when in fact, there’s a very important intermediary doing the bulk of the work for over 80% of employers […]


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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 […]


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How Can Pharmacist Forecast Revenue In 2018?

A recent survey forecasted that the pharmacy automation market will hit $8.8 billion in the year 2018. In the year of 2011, the pharmacy market was valued at $4.7 billion and nearly 60% of the generated revenue came from automated medication dispensing system. Pharmacists believed that this pharmacy segment is expected to see a compound […]


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