Streamlining Pharmacy Billing Processes in Physician-Based Clinics

Clinical care is becoming more common in pharmacies as more pharmacists seek to provide
services other than filling prescriptions. And while providing clinical care can be a game
changer, especially for independent pharmacies struggling to compete in a highly competitive
industry, getting compensated for those services is both necessary and challenging.
New Era Pharmacies, or what we consider to be the pharmacy of the future, understand how
to be compensated not only for the prescriptions they dispense but also for the clinical care
services they provide to patients. Even the most knowledgeable and experienced independent
pharmacists must begin somewhere, and getting it right necessitates the right tools,
knowledge, and resources to ensure complete and timely medical reimbursement. This article will helps to Streamlining Pharmacy Billing Processes in Physician-Based Clinics.

Tips to Streamline Pharmacy Billing Processes:

Despite having some of the best healthcare in the world, Americans have one of the most
expensive systems. According to the Centers for Medicare and Medicaid Services (CMS),
healthcare spending in the United States increased 4.6% in 2019, reaching $3.8 trillion, or
$11,582 per person.
The complexity of prescription billing and reimbursement significantly contributes to rising
healthcare costs. Complicated processes lengthen the time between providing care, billing, and
receiving final payment or reimbursement. Only complete or correct information given to
patients also causes issues. Patients must be more informed about treatment costs, care
options, and payment options. This raises overall healthcare costs and may limit access to
adequate care for uninsured patients. That’s why there is a need to streamline pharmacy billing
processes in physician-based clinics, and here are a few tips:

Tip #1: Put the Patient at the Centre

Physician-based clinics can have a good pharmacy billing process, but first, they must improve
patient relationship management. If the clinic’s staff prioritizes patients’ needs and believes in
improving patient satisfaction, it will help build a strong relationship and loyalty with the
patient. Staff must provide patients with both verbal and written descriptions of their financial
responsibility, deductions, copays, the preferred mode of payment, and the best time for their
visit, among other things. Intimidation, frustration, and confusion may result from a lack of
good relations, affecting the clinic’s status.

Tip #2: Update Technology

Many claims are automatically denied when submitted most of the time. This could be due to
outdated technology, so keep clinics up to date on diagnostic codes and requirements. It takes
a long time to search for and resubmit unpaid claims. If the clinic has automated software
systems, they can streamline eligibility checks, pharmacy coding, and prior authorizations and
notify you of any errors before submitting claims. Modern technology may shorten the time it
takes to receive reimbursements.

Tip #3: Improve The Charge Capturing

Physician-based clinics must develop and implement processes to capture revenue for patient
services. Outpatient nursing procedures, such as injections given to patients, are examples of
areas that can easily escape charge capture during the pharmacy billing process. Other times,
pharmacy revenue is lost due to errors in unit reporting. Thus, nurses and pharmacists should
check for missed charges and other documents to ensure proper reporting of missed

Tip #4: Capture the Patient’s information

This is the most efficient method of pharmacy billing as most physician-based clinics have
much more relevant data than just the patient’s active insurance provider, contact number, and
personal address. Access to information such as preferred times of contact, email addresses,
and other details can help to strengthen the doctor-patient relationship. It also increases the
likelihood of contacting the patient about critical information in less time, resulting in
immediate solutions.
Furthermore, patients are pleased and appreciate the clinics’ use of this effective method.
However, it is also critical that every healthcare professional’s clinic adhere to HIPAA
regulations, particularly concerning privacy. Efficient medical pharmacy billing allows the
healthcare system to focus on the essential aspects, resulting in the best possible patient care!

Bonus Tip: Outsourcing Pharmacy Billing

Undoubtedly, pharmacy billing services are one of the most critical aspects of healthcare.
Specific billing challenges are integral to physician-based clinics, just as they are to other
disciplines of healthcare billing. The fact that some drugs and injections are not covered by
insurance adds to the complication of pharmacy billing. As a result, expert knowledge is
required to understand the efficacy of including or excluding drugs during the pharmacy billing
process. Physician-based clinics can better focus on their core business competencies with
comprehensive and customized pharmacy billing services of 24/7 Medical Billing Services and
follow-up on the above mentioned tips.

See also: Know About Prior Authorization For Prescription Drugs

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