Pharmacy billing services Archives - Pharmacy billing and coding blogs

Medicare Part D Overhaul: What the $2,000 Cost Cap Means for Pharmacies in 2025

The healthcare system in the U.S. is changing in big ways, and one of the most important updates coming in 2025 is the new $2,000 out-of-pocket cost cap for Medicare Part D. This change is set to make a huge difference for pharmacies, healthcare providers, and everyone involved in the pharmaceutical industry. But beyond patient […]

Role of pharmacist in digital health era

COVID-19 pandemic has accelerated the digital health era. Digital health includes various advanced technologies such as telehealth, health apps, medication reminders sent via email or text, and remote patient monitoring. The remote patient monitoring will continue to expand and integrate creating a hybrid of in-person and virtual care. Human touch is getting augmented with these […]

Is your biller doing the right data handling and follow up in pharmacy billing management?

In the healthcare industry Pharmacy is an integral part just like other disciplines in this field. However, it also poses certain billing and coding challenges that may often be difficult to manage internally. Also, because certain drugs are excluded from the insurance provider’s coverage where only a few injections and adjuvant therapies allowed, it may […]

Pharmacy medical billing: Lower Drug Prices in Medicare Advantage and Part D

CMS is allowing Medicare Advantage plans to cross negotiate Part D drug prices Starting in 2019, insurers may use step therapy to choose the least expensive drug first before moving on to another prescription. For the first time in the history of healthcare US, Medicare Advantage plans that also offer a Part D benefit have […]

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 […]

Physicians To See Increase In Medicare Part B Payment Despite 340B Cuts

The recent research reveals that about 85% of the hospitals in USA will witnessing a raise in their Medicare part B because of the recent changes in the Medicare outpatient payment charges hence; medical coding too get revised. The Medicare payment charges came into effect on January 1, 2018 which had revealed a major reimbursement […]

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 […]

Accountable Care Organization (ACO’s) Needs Tech-intelligent Pharmacist

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With an effort to access and improve the healthcare industry in USA; along with managing the costs which have been the primary issue since years; the introduction of ACO (Accountable Care Organization) whereby the providers have created a comprehensive network that works for the betterment of the patients, and it is appreciated as an achievement […]

What Happens If Your Prior Authorization Doesn’t Match With Service Provided?

Prior Authorization for a drug is one of the foremost processes on which the financial health of a Pharmacy facility depends on. Today, with the advancement in the areas of EMR and EHR, Pharmacy billing personnel who work in-house or offshore have to guarantee in advance to their doctors about the patients insurance plan. While […]

Insurance vs. Out-of-pocket Payment: Which Option is better for Pharmacist?

Having a pharmacy business is no easy task considering the nature of Insurance versus out-of-pocket expense that both the patient and the pharmacist have to abide by. The pharmacy benefit manager (PBM), most of the time charges their customers more than the medicine costs and pockets the leftover difference. This is where an efficient, relevant […]

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