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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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 […]


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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 […]


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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 the fact […]


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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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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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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 […]


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How The Year 2017 Spanned Out For Pharmacy Billing?

Pharma industry has been described as having a “roller coaster ride” in the year 2017 by The Pharmaceutical Journal. Inadvertently, one might assume that the industry is on the downswing but on the contrary it is on its ride up. Pharmacy billing is in big league in the pharmacy billing management as it is a […]


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How Can Independent Pharmacies Deal With Underpayments?

Have you ever stopped to think about how much your independent pharmacies are earning when it dispenses your medication? It turns out that pharmacies, particularly independent pharmacies, sometimes wind up losing money on those prescriptions. That’s largely due to the low insurance reimbursement rates middlemen, known as pharmacy benefit managers, or PBMs, pay pharmacies and […]


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