All You Want To Know About Pharmacy Billing
In
healthcare services, pharmacy billing is a crucial aspect. Like other healthcare
disciplines, pharmacy billing too has its challenges, which are integral to
pharmaceutical companies. There are some drugs and injections that are excluded
from the coverage provided by the insurance. It eventually adds to the complexity
of the pharmacy medical billing and coding. It is therefore essential that the
pharmacy billing staff have a thorough knowledge and understanding of the
efficacy that includes and excludes the drugs and other items during the
billing process.
Overall,
pharmacy billing plays an effective part in the patient's care and the revenue
cycle management of a facility.
Understanding
Pharmacy Billing?
The
management of pharmacy
billing and coding is handled best when a professional takes over the
work. With the customized and thorough billing service, the pharmaceutical
company and the medical services can focus on their core aspect while the
professional take care of the billing.
Types of Pharmacy Billing
You
should be aware of the different categorizations of pharmacy billing which are
as follows:
·
Home care pharmaceutical
billing
In
today's healthcare system, there are many home-bound patients. For this pool of
patients, the data needs to be maintained and handled efficiently. Pharmacy
billing and coding experts might have to visit the patient's home to collect
the bills, and there is no room for error when submitting a claim.
·
Managed care
Managed
care is operated from care centres and big hospitals, and the bills are
reimbursed via a bundled payment model. It hence requires precise paperwork and
data handling for maintaining the non-clinical reports.
·
Radio
One
of the most proficient adjunct services is the radio drug. Accurate pharmacy coding
is required to fulfil a full-proof pharmacy billing and coding and to get the
maximum deliverables with this service.
Factors Impacting Reimbursement of Pharmacy Billing
A
report published by Drug Trend predicted that the price increase from biotech
and traditional branded drugs would continue to increase due to the lack of
generic drugs. CMS has further reduced the Average Sales Price (ASP) from six
to four percent for non-pass-thorough drugs. As a result, it has affected the
reimbursements of the pharmacies. Certain other aspects can impact the
reimbursement process of the pharmacy billing and coding if the revenue cycle
management is not implemented correctly.
Some
of the factors that impact pharmacy billing and coding reimbursements are:
Data
Workflow
To
ensure full reimbursement for a drug sold or administered, the pharmacy must
take care of the entire workflow. It starts with the procurement, inventory, and
billing, the process of purchasing the medication, storing, and method of
administering or dispensing it to the reimbursement. The way the pharmacy codes
and bills it is also an essential part of the procedure. If any information
entered is incorrect, the revenue cycle will be disrupted. Also, the
reimbursement of the drug fails to be realized.
Procurement
This
phase is vital in converting the purchased quantities and pricing information
to the storage unit of measure. It also takes into account the costs of inventory.
Any mistake at this phase can disrupt the revenue cycle management.
Charge
Master
Often
in pharmaceutical billing, a revenue leakage occurs at this phase when
reimbursable medications are miscoded or missing in the chargemaster.
The pharmaceutical quantities are required to convert from the amount purchased
to the amount administered to the patients. The drug can be billed only when a
proper charge master is in place.
Coding
Every
drug needs to be codded appropriately with the HCPCS code. Any incorrect coding
in the chargemaster means the liability is shifted to the payer or the patient.
It then leads to the hospital or the health service provider being unable to
get the reimbursement.
Linkage
between Purchase and Billing
Typically
a hospital maintains a separate process for ordering drugs, administering them,
and processing the reimbursement. However, every hospital should have an
automated tool to keep a linkage between all three to ensure no error and a
proper refund can occur.
Rules,
Regulations & Compliances
The
company's admin should be able to keep track of all the CMS regulations and
ongoing changes related to the drugs and pharmaceutical billing. It will ensure
lowering the risk of reimbursement rejection and maintaining the revenue cycle
management running smoothly.
Wants
to Get Reimbursed for Your Drugs Every time?
It's
time to let someone else, an expert do the heavy loading with the complex
nature of pharmacy billing and coding while you can focus on your core
objective. Working with a third party to whom you can outsource pharmacy
billing and coding and revenue cycle management is the best way to ensure you
get reimbursed for your services.
We
at 24/7 Medical Billing Services work very closely with medical health
facilities of all sizes and helps with pharmacy billing and coding to ensure
the revenue cycle management is at the top. A team of experts is always there
to help you while you take care of serving the patients better.
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