Streamlining Pharmacy Billing Processes In Physician-based Clinics

By Author: Danny Johnsmith
Total Articles: 411
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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 payments.
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.

I am Danny Johnsmith & I work as a Healthcare Consultant with 24/7 Medical Billing Services. I have been working in the US Healthcare Industry for more than 4 years now & I excel in offering Revenue Cycle Management Services. Ideally, Physicians should be focusing more on Patient Care & spending very little time in the administrative tasks. But in reality, a lot of Physicians & Healthcare Providers are actually burdened with both – Patient Care & the Office Management to. And that’s where My services would be of real help for you… From Credentialing to Appointment Scheduling, From Medical Billing to ICD 10 Coding & From A/R Follow-ups to Denial Management, I can help streamline your entire practice performance. Be it DME Billing or Chiropractic or Mental Health, I have helped a few Providers boost their practice revenue by at least 50%.