Top Challenges Associated With Pharmacy Billing Services
Like
any other medical billing in healthcare, pharmacy billing has never
been easy because of its complex procedures and frequent regulation updates.
For clinical services provided by a pharmacist, the billing format is different
from that of a provider which makes it all the more complicated.
Here are a few challenges commonly
faced in pharmacy billing services
Staff issues –
- There might be a case of the roles and responsibilities
not being identified properly during billing. Sometimes, pharmacies may
also settle for inexperienced billers which causes issues like incorrect
modifier usage, improper billing calculations, etc.
- Another major challenge can be when the staff isn’t
aware of the updates in the billing system. The staff should always have
accessible resources with updated information about the various drugs and
their codes.
- The staff might not always be aware of the maximum
dosage requirements of each drug.
- There are only certain drugs, injections, and therapies
that are covered under insurance. The staff of the pharmacy needs to
assess them correctly if it is worth including or excluding the services
during billing.
- Shortage of staff may lead to problems like wastage of
time and energy, especially during handling critical cases.
Customer issues –
- There might be missing or inadequate information on the
allergies caused by different drugs in the system. The pharmacy vigilance
department keeps sending updated information time-to-time. This can be a
problem in customer service and loss of reputation.
- There may be many challenges in the process leading to
poor quality of customer services, hence becoming a problem in building
customer relations.
- Customer service can be delayed if the staff takes time
to look for the codes while billing. Hence, the focus on customer service
reduces.
System issues –
- Your billing system may not be updated with the latest
technology, which can cause hindrance in patient billing.
- The billing system may not be updated with all the
latest government rules and codes for various drugs. Your staff also needs
to be given training at the same time, so that they can also adapt to the
new rules.
- The system you use may not be flexible. Systems may not
process vaccine claims or medical benefits, which may cause an issue. In
this case, staff may submit claims resulting in a waste of time because of
claim denials later.
- Your system may not be scalable, especially in cases of
in-house billing systems. A wrong Charge
Description Master (CDM) may result in fines, claim
denials, and underpayment.
Aging Accounts Receivable (A/R)
This
is one of the most common challenges faced by pharmacies. When old accounts
exceed 90 days, they get ignored. The money owed to providers may go on
increasing and there isn’t any specific strategy to deal with it. Your huge
accounts may need attention and new strategies to recover all the outstanding
accounts.
Incorrect
payments may occur due to errors while submitting data and can lead to wrong
A/R calculations. It can later cause a huge issue on budget planning and
revenue.
Inadequate document codes
- There may not be adequate document codes for all the
drugs in the system and hence can create a major problem while billing.
- Inadequate information, missing medical records, or lack
of updated drug codes in the system can cause frequent claim denials.
Last
but not the least, frequent errors like these can invite the attention of
auditors and may have major implications like huge fines or cancellation of
contracts.
Some tips to ensure smooth functioning
- Maintain centralized and automated IT systems to avoid duplication
and errors.
- Keep updating your system and staff with up-to-date
information on drug codes and government rules.
- Try integrating your inventory management with your
billing system.
It
is extremely important for pharmacists to stay up to date with the Current
Procedural Terminology (CPT) and Healthcare Common Procedure Coding System
(HCPCS) to be able to bill for medical benefits availed by patients for their
insurance plans.
Although
these challenges can be overcome by streamlining the whole process, pharmacies
may prefer outsourcing pharmacy billing services.
If
you’re looking to outsource to a trusted company, 24/7 Medical Billing Services
provide end-to-end services at affordable costs for your pharmacy. We ensure to
take care of all your needs so that you can focus more on excelling in customer
service.
About 24/7 Medical Billing Services:
We are a medical billing company that offers ‘24/7 Medical Billing Services’ and support
physicians, hospitals, medical institutions and group practices with our end to
end medical billing solutions. We help you earn more revenue with our quick and
affordable services. Our customized Revenue Cycle Management (RCM) solutions
allow physicians to attract additional revenue and reduce administrative burden
or losses.
Contact:
24/7 Medical Billing Services
Tel: +1 888-502-0537
Comments
Post a Comment