Medical Billing Expert

Outsource Pharmacy Billing Services

We Strive to Improve Bottom-line with Improved Billing



Pharmacy Billing Services Made More Accurate and Customized for Your Unique Needs

An ever-changing regulatory framework, existence of multiple payers, multiple locations of pharmacies, among others are some of the critical factors that hinder accuracy in billing for pharmacy services. This is detrimental for enterprises who seek to improve their customer relations and boost their topline revenue.The lack of the resources with the requisite expertise, adequate technology adoption, and proper operational system derail the entire pharmacy services billing process. In a hyper-competitive marketplace, billing for pharmacy services is witnessing unique challenges which require industry-specific focus for their resolution.

MedBillingExperts provides comprehensive and customized pharmacy billing services to help you handle pharmacy management with greater accuracy. Leveraging our in-depth understanding of the business process, we have been able to deliver the highest levels of customization so as to keep the system as close to reality as possible. This has helped us to greatly reduce the difficulties of clients to get accustomed to our system. Another very important salient feature of our pharmacy billing services is the highly reduced operating cost. Also, our billers strictly abide by coding rules and HIIPA compliance guidelines. We document drug category review and carry out compliance audits to reduce drug coding errors. All these steps guarantee accurate billing and reimbursements.

video for medical billing services

Here's How We Ensure Effective Pharmacy Billing Services for you

  • We are well adept with transitional care billing codes that allows us to cover billing for patients who were discharged from a skilled nursing facility.
  • Our team of experts stay abreast of the dynamic regulations and stay compliant with CPT codes and coding guidelines that are critical for error-free billing for pharmacy services.
  • We ensure that all the purchased drugs have appropriate HCPS coding. Any discrepancy in this respect will lead to reimbursement denial for the pharmacy.
  • We have different processes for A-rated Generic Drug, Brand Name Drug, and Non-Preferred Drug, which helps us minimize rejections.
  • We maintain a pharmacy charge description master that enlists all the billable items which are converted to patient administered quantities. These are reviewed to ensure zero revenue leakage.

Our end-to-end Pharmacy Services Billing Process

Details Receipt

We receive and access details from the Pharmacy Benefit Management (PBM) team through secured FTP tools. It is followed with negotiation with manufacturers for better discounts

Verification of details

The negotiation is followed by a thorough verification of patient details including name, SSN number, address, physician details, among others.

 

Document Verification

Each document a thorough scrutiny and is then shifted to a data format that can be read by a system.

Check for Drug Refill

The data is then processed for medication refill check to understand the quantity of drugs in view of the prescription duration.

Identifying Prescribed Drugs

It involves the identification of the brand term of the prescribed drugsand suggestion of generic terms for molecules.

 

Placing the Order

We place the order in our client’s software, copies of which are sent to the patient and the insurance provider.

Tracking the Order

We ensure a prompt delivery of the consignment to the patient; any issues are quickly escalated to the logistics team.

Billing Management

Post receiving payment checks, we update the billing software and trigger reminders for payment due dates.

Our Pharmacy Billing Services Cover Your End-to-End Needs

Admissions

It is the first step in the billing for pharmacy services. It has a major involvement of resources where our team captures all the crucial patient details such as medical reports, patient clinical histories, previous prescriptions, visits to physicians, among others. Our professionals are specialized at executing this task with speed, confidentiality, and accuracy. Our trained and experienced pharmacy billing experts use latest billing tools to capture every minute detail pertaining to the patients.

billing for pharmacy services
daily census updates

Daily Census Updates

Upon a medical claim been made, it is essential to keep a document of all the critical information pertaining to diagnosis summary, physician contact details, patient medical reports, discharge summary of patients, among others. Our enumeration services will accurately document the patient and payment records to speed up the medical claims process and provide a daily census update. Our pharmacy billing services allow you to automate the process of recording and producing critical information related to the patient and payee. This gives you room to focus on your core functionalities.

Prior Authorization Data Management

Our team with expertise in specialized authorization deals with a range of drug classification and pharmacy codes while ensuring utmost precision. Our billing for clinical pharmacy services are specifically designed to ensure that authorizations are done before billing. This curbs the chances of claim denials in situations when patients use complex health plans. It also helps to ensure that the patients are covered at all times via a healthcare plan.

Prior Authorization Data Management
Refill Management

Refill Management

We deploy our team of expert medical billers and coders who execute the task of medical refill management by aiding patients and revisiting customers who seek a prompt and accurate meds refill. We strive to satisfy our clients as we diligently align our services with pharmacy code guidelines to process refills without any delay. In addition, we set up timely reminders for customers for their medical refills. This goes a long way in building a mutually beneficial vendor-customer relationship.

Accounts Receivable Follow-up

Any instance of unbilled service has a severe implication on the prospects of revenue generation for the provider. In order to prevent this, we make sure that the pharmacy billing services we render undergo comprehensive billing without any chance of lapse. In addition, we set up follow-ups with patients and insurance providers to make sure that all the payments are transacted accurately and on a timely basis. Our services also carry the burden of following-up with patients or vendors so that you can enjoy the benefits of timely and accurate returns.

accounts receivable follow-up
payment posting

Payment Posting

Billing for clinical pharmacy services require intensive involvement of manpower which not only entail time but a sizeable proportion of an enterprise’s budget. We have an arsenal of the most cutting-edge technologies that allows us to automate pharmacy billing services. From limiting the amount of time invested on data entry to organizing manual payment postings, our solutions ensure that all the reimbursements are accurately accounted on a timely basis.

Our Specialties

Why are we known as an Industry Authority in Pharmacy Billing Services sector?

Compliance

As an ISO certified and RBMA corporate partner, we strive to offer high-quality pharmacy billing services to meet al HIPAA requirements.

Accuracy

Our in-depth knowledge and hands-on experience in billing processes for various non-branded/branded, and A-rated generic helps us minimize errors in services.

Data Security

We have a robust digital and physical security framework to maintain confidentiality of the massive amount of clinical data that we deal with.

Better Turnaround Time

Our professionals bank on a well-defined process to help you save over 30% of time in delivering pharmacy billing services.

Scalable Services

We offer to scale our solutions as per your needs for hours. We promise above 80% scalability in our services which allows to boost your ROI.

Technology Adoption

We leverage advanced tools to accelerate tasks such as data capture that smoothens as well as speed up the reimbursement process.

Read What Our Clients Have to Say About Our Billing for Pharmacy Services

Director, Multispecialty Hospital, New York, USA

We are a multispecialty healthcare organization which meant that we witnessed a massive amount of clinical data on an everyday to process. Lack of expertise, time, and the proper infrastructure were taking a toll on our limited manpower who regularly being flagged for committing errors while documenting codes for drugs. Invariably, these frequent mistakes resulted in incorrect payments whose repercussions could be felt on our bottom-line revenue and budget strategy. After a thorough scrutiny, we decided to partner with MedBillingExperts to who we outsourced the billing for clinical pharmacy services. We have had a satisfactory partnership with the team who has displayed impressive skills in getting the job done with accuracy and acceleration. We have witnessed them taking the extra mile in ensuring there are no erroneous document of drug codes and that definitely worked in favor of our operations and above all a noted difference in our revenue. We can’t thank the experts at MedBillingExperts enough!

CFO, Leading Pharmacy Chain, Rhode Island, USA

We started off as an independent pharmacy who were on an aggressive front to seek a foothold in the market. We had the zeal but lacked the expertise to achieve our goal which was primarily to improve our revenue generation. We needed guidance to identify the right services which if rendered to patients and physicians can be highly profitable for us. Upon multiple recommendations we decided to join hands with MedBillingExperts. They were not just vendors but our business partners who have helped us move ahead in the growth curve. They have helped us identify the most profitable prescription services that enabled us to position ourselves better to physicians. They assisted us in delivering pharmacy billing services without letting us lose the control on the overall operation. It has been a five long happy and a fulfilling journey with MedBillingExperts.

 

 

97%

Clean Claims On First Submission

24/7

Support

100%

HIPAA Compliance

25%

Increase in Collections

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Our Healthcare Software Expertise

Software Tools We Use for Medical Billing and Coding Solutions