Ensuring Successful Pharmacy Billing

Pharmacists play a major role in providing healthcare services to patients by physicians. And for all of us, these services are not a new thing. For years, pharmacists have been offering services over and above filling prescriptions from the origin of the profession. One of the developments in the pharmacy profession is, however, getting compensated […]


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Service expectations to have from Specialty Pharmacy

Specialty pharmacy refers to the channels of distribution designed to deal with specialty drugs. Medications used to treat rare or complex health conditions are provided by a specialist pharmacy. Many times, most people don’t use these drugs, so a local pharmacy wouldn’t hold them in stock. For patients in need of access to prescription drugs […]


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Medicare Advantage and Part D Advance Notice for CY 2022

CMS released the Part I of the 2022 Medicare Advantage and Part D Advance Notice to provide plans with earlier notification of proposed payment changes. This announcement is made three months earlier than the usual to provide Medicare Advantage organizations and Part D sponsors more time to take this information into consideration as they prepare […]


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Avoid the Part D late enrollment penalty

Do you have creditable prescription drug coverage? It’s drug coverage that’s expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage. It could be drug coverage you get from a current or former employer or union, or from TRICARE, or the Department of Veterans Affairs. If you don’t have creditable coverage, you […]


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Pharmacy Billing and Reimbursement

Conventionally, pharmacist compensation has been majorly concentrated on collecting payment for the products’ provision, such as prescription medications. Nowadays, pharmacists possess an extended practice opportunity and the pharmacy profession has integrated different clinical avenues into regular patient care such as medication therapy management, chronic disease management, and care transitions interventions. A prescription has multiple stages […]


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TIPS FOR SUCCESSFUL PHARMACY BILLING IN 2020

Pharmacists perform a significant role in providing healthcare services to patients. And these services are not a new thing for all of us. Pharmacists have been offering services beyond prescriptions filling for decades from the origin of the profession. However, getting reimbursed for delivered services is one of the developments in the pharmacy profession. Moreover, […]


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Key Points about Pharmacy Billing and Reimbursement

From the pharmacy to the side of the patients, the prescription has multiple phases of reimbursement for patients as well as pharmacies. Distributing medication from your own hospital could be one of the efficient as well as an effective way for revenue generation. The health care industry has transformed unconventionally over the past few years […]


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Understanding Prescription Insurance Claim Process

After submitting a claim from the pharmacy, it will then hit a service that routes the claims to the proper insurance company or PBM based on the identifiers. These are known as ‘switches’; examples of companies that offer switching services include RelayHealth and Emdeon. Switches usually charge a fee for every transaction, although they might […]


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Pharmacy Claims and Commercial Payers

The most common categories of commercial payers to be aware of are employer-sponsored health plans and manufacturer vouchers. In the case of the patient with commercial coverage, by law, it is billed before Medicaid and Tricare and is almost always the primary payer. A common misunderstanding among patients with manufacturer vouchers (i.e. ‘co-pay cards’) is […]


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Maximizing Reimbursement and Minimizing Liability by Using Pharmacy Audit

Payers audit pharmacies because of billing history, a referral from an FWA hotline, a routine, random audit, or other reasons that might signify a potential for FWA to the payer. Often it is in the form of a desk audit, where the pharmacy will be required to fax documentation back to the payer, but can […]


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