Why is Experience and Expertise a Necessity in Pharmacy Billing?

Pharmacy billing cannot be taken lightly; of course advances in technology do help in removing the monotony and glitches associated with such repetitive tasks. It is indeed quite a challenge to be able to survive with competition breathing down your neck and wafer-thin margins threatening to eat into your revenues. Pharmacy companies are increasingly moving to automated systems. One important aspect is the billing function which is virtually a daily function that requires a bit of juggling and precision. A thorough understanding of the pharmacy billing process will benefit the pharmacists to a great extent and elaborate on the fact that experience and expertise can bring profitability to the pharmacists.

Make sure you sign up with NCPDP

The first thing any pharmacist needs to do is to sign up with the National Council of Prescription Drug Programs (NCPDP) that allows pharmacies to the bill. The NCPDP on its part will provide a unique six-digit number, which is the BIN that has to be quoted while billing.

How third-parties function

It is important to know that the fact of the matter is that insurance companies never do their own billing. Every payor has a tie-up with a third party, like Express Scripts or Medco, the Pharmacy Benefit Managers (PBMs)  who are intermediaries that are billed each time a prescription is filled out, and they also carry out the auditing of the files to ensure everything is perfect so that the insurance company knows that due diligence has been done.

The entire pharmacy billing cycle right from patient authentication to payments needs to be handled with dexterity. For instance, admissions being the first step in the entire medical billing process needs attention. This critical area of the process is quite sensitive as all the details of the patients need to be captured accurately including their complete medical history, details of previous medications, prescriptions for reference, all medical reports, details to visits to doctors need to be recorded correctly.

You should understand that when a beneficiary makes a medical claim, the vital information like the contact details of the doctor, diagnoses and course of treatment provided, patient’s medical reports, any second opinions or changes in physicians, patient discharge summaries, etc., need to be documented correctly. The pharmacy billing companies need to adopt correct census maintenance and document records in relation to the patients and the payee, which will certainly help process claims without any unnecessary delays.

Role of Pharmacy Billing Companies

All drug categories and emergency codes need to be handled without any errors, and due authorizations need to be obtained before the bills can be processed. This will ensure that patients do not suffer unnecessarily due to claim denials that can cause a lot of hardships. Similarly, repeat patients need not be made to wait unnecessarily and should be attended to immediately. This can be done by processing refills without taking too much time, and here is where pharmacy billing companies can help by sending reminders at appropriate times and ensure that beneficiaries are always kept happy.

It is the responsibility of pharmacy billing companies to diligently follow up with accounts receivables. Even the biggest of companies cannot afford to delay the billing, which in turn affects the payment process. Every service delivered to the beneficiary needs to be recorded accurately and then billed without errors. Promptly follow up with vendors and patients helps in realizing the payments on time.

Payment posting is another area of concern as it is probably the most labor-intensive task in the medical billing industry. All manual payment postings need to be streamlined so that reimbursements are realized on time. The pharmacy billing companies need to work in close coordination with the clients in order to understand their requirements and offer the perfect solutions that ensure better cash flow, and satisfactory customer service and billing with no unnecessary delays.

Thus, it is amply clear how experience and expertise go hand in hand in achieving profits in Pharmacy billing by collecting as much as possible.