Pharmacy Billing Services

Pharmacy is an integral part of healthcare, and, just like other disciplines of healthcare, it also poses certain billing challenges that may often be difficult to manage internally. Moreover, because certain drugs are excluded from insurance coverage and only a few injections and adjuvant therapies allowed, it may require experts to judge the efficacy either including or excluding the drugs during billing.

To complicate matters further, pharmacy-related reimbursements require multiple levels of data handling and follow-ups as in most cases. Although it is a separate set of medical service and provided from a separate facility, claims are prepared and submitted together by hospitals or nursing homes – either because they come later in the care chain or because it forms a small part of the care services hospitals provide. This joint-claim preparation and submission leads to a greater potential for inaccurate Data handling and denied claims.

And, even though pharmacy claims are distinct from hospital claims, they are still subject to the same HIPAA rules – which may be difficult to cope with during times of resubmission for being non-compliant with privacy or security norms.

These inherent challenges require a series of admin and data related activities, starting from verification, through claim preparation to submission, to be handled with accuracy.

Our pharmacy medical billing and coding services would not just help you accurately discern which type of treatment comes under injectable or adjuvant therapies but also take care of the entire range of your admin activities from claim preparation thorough submission to post-submission follow-ups and audits in case of over payment by the insurer, improving your finances and leaving you with more time to spend on your core competency – pharmacy dispensing.

Our services cater to all kinds: clinical, home care, and radio pharmacy services.

Clinical – these services often come under bundled payment module, which may require handling paperwork of non-clinical nature. We take care of the entire paper trail that adds up to insurance claims in a methodical manner.
Home Care – involved in preparation and delivery of injectable to home-bound patients, these services being covered by Medicare Prescription Drug Improvement and Modernization (MPDIM) require you to prepare and maintain details and do data handling that is not part of your core competency and interfere with their itinerant schedule which involves extensive travelling to patients’ homes. We have an extensive network spread across all states of the US and professionals who are experienced in handling billing activities related to home care services.
Managed Care – like clinical services, these services are often operated from big hospitals and nursing homes that often realize their reimbursement through the bundled payment model. This requires maintaining non-clinical paperwork and producing reports, slicing away from the time you spend on patients and exposing them to data and procedural inaccuracies which often count against their performance as being part of these establishments. Our end-to-end billing and coding services spare you the challenge of having to maintain your non-clinical paperwork letting you spend more time on drug dispensing.
Radio – being among the most prominent adjuvant therapy services, these services come under the insurance coverage of the Medicare Prescription Drug Improvement and Modernization Act (MPDIM) and require billing and coding assistance. Our medical and billing and coding services have helped many a Radio drug service providers improve their finances through efficient data handling, bill submission and follow-ups.

How We Do

Daily Census Updates

Census maintenance is a very important function from medical billing point of view, as it involves creating proper records of the patient and the payee. It involves recording information of patient discharges, change of physicians, etc. All this is essential especially if your customers plan to make a medical claim.

Admissions

Admission is the first step in the medical billing process, and involves recording the details of the patients like their name, age, blood group, medical history, diagnostic reports, previous prescriptions, known allergies, etc.

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Prior Authorize Document Management

The billing management systems we develop ensure that complete authorizations are taken before the processing begins. This ensures that the patients are always covered via a health plan and there are minimal claim denials. Our authorization systems are set to handle every drug category and emergency levels.

Refills Management

Refill management is another area that requires great attention and quicker actions, as your customers are not going to be very patient with you the second time they come around. We will help you set up all the necessary approvals and reminders, so that when a customer comes in for a refill, you can process it right away without any delay.

Payment Posting

This is probably the most labor intensive activity in pharmacy billing, but the good news is that we can automate it. We will help you streamline the manual payment postings, automatically post the insurance payments, and also reduce the data entry time.

AR Follow-Up

AR stands for accounts receivable. We know that every small service that doesn’t get billed impacts your bottom line directly, so we take care to handle it with a lot of attention and care. The most important aspect of this service is to ensure that only the services performed are captured and billed at the right time.

Our Value

Our team of experts comprises of well-qualified and experienced accounts and finance personnel, and clinical experts who have complete working knowledge of
CPT codes and coding guidelines
Documentation for drug category review
Different processes for A-rated Generic Drug, Brand Name Drug, and Non-Preferred Drug, which helps us minimize rejections
Awareness of all compliance audits, thereby reducing the drug coding errors
Creation of tailor-made statistical and analytical reports for the clients
Each member of the team is highly motivated and aims at delivering results in the shortest span of time with maximum efficiency. They ensure constant increase in cash flow and consistent reduction in costs.

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