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 great time for pharma industry.
Though pharmacy has been affected with some issues namely medicine supply supervision, decriminalization of drug dispensing errors and others. It has focused on integration of primary care services and aims to pressure government to take off low value and cheaper medicines from prescriptions.
Pharmacy billing service is a complex system and difficult to comprehend especially by pharmacists new to the field. Pharmacy billing involves various parameters like multiple payers, different institutional and non-institutional locations where services have been rendered, differences in rules and regulations of various states, and the frequently overhauled legislative process. Health care billing language is full of jargon in terms of words and abbreviations which often delay billing. Presently the health industry is striving to move from current fee-for-service model to value-based-payment model. The Centers for Medicare and Medicaid Services (CMS) had passed an outcome based reimbursement legislation in 2016 but pharmacists and pharmacy billing management systems are still trying to fully comprehend the repercussions to the bottom-line from this legislation often referred to as ‘pay-for-performance’ and ‘value-based payment reform’. Year 2017 has not completely changed the current system but aims to lay foundations for the newer pharmacy medical billing service systems to be put in place in the coming years.
Pharmacists need to make themselves aligned with the new quality based payment models so that they can either meet or exceed the requirements. Their contribution in terms of personalizing patient care plans, medication synchronization, screening for co morbid conditions and performing routine medical procedures will enable them to bill for these services when they work in tandem with a provider under collaborative practices agreement. Pharmacists can impress upon the providers about how their services can affect patient health outcomes positively. Pharmacists have not gained general acceptance as health care providers but they are increasingly being perceived as an ancillary to an eligible provider who may bill for a pharmacist services. Pharmacists are increasingly being recognized as an important link in positive healthcare outcomes because of their clinical contributions. Pharmacists are being engaged to act in newer capacities and the use of technology is helping them to deliver improved personalized care. The year paved the way for new responses and opportunities in pharmacy billing optimized by the presence of big data, digitization and artificial intelligence. It’s best to avoid getting stuck in the debates on automation and centralization. If the pharmacy industry is to grow substantially in the coming year, then it needs to embrace the change and accept the fact that there is always scope for improvement in the pharmacy billing service.