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Pharmacy Medical Billing: Tips and Tricks for Getting it Right

Clinical care is becoming a mainstay in pharmacy as an increasing number of pharmacists look to provide services beyond filling prescriptions. And while offering clinical care can be a game changer—especially for independent pharmacies fighting to keep up in a highly competitive industry—getting compensated for those services is both essential for success and easier said than done.

New Era Pharmacies, or what we consider to be the future of pharmacy, know how to get paid not only for the prescriptions they dispense but also for the clinical care services they provide for patients. However, even the most experienced and knowledgeable independent pharmacists have to start somewhere, and getting it right requires the right tools, knowledge, and resources to ensure full, timely medical reimbursement.

Struggling to get your medical billing practice up and running quickly? Use these tips and tricks to use as a guide while navigating the complex world of pharmacy medical billing:

Invest in Comprehensive Medical Billing Training

The first step may seem like a no-brainer, but medical billing training must be comprehensive and engaging in order to be effective. Look for readily available resources such as on-demand webinars, e-books, and point-of-care education programs to ensure pharmacists and technicians receive adequate medical billing training and learn the ins and outs of submitting claims for reimbursement such as:

By investing time and energy into medical billing training, you can avoid costly outsourcing fees and introduce workflow efficiencies that prevent unnecessary payment delays. This way, your team can work smarter, not harder, and you can make sure you’re always getting paid on time for the clinical care services you provide. Additionally, everyone being trained to follow standardized medical billing processes ensures consistency across the board and protects against potential workflow interruptions.

Improve Your Clinical Care Documentation

There’s a known saying in the healthcare industry: If it’s not documented, it didn’t happen. Clinical documentation plays an important role when it comes to submitting for medical reimbursement. That means each time you offer patient care beyond filling prescriptions—think immunizations, chronic disease prevention and management, medication therapy management, smoking cessation, diagnostic testing, and durable medical equipment (DME)—it must be properly accounted for in order to get paid.

To improve clinical documentation in your pharmacy, start by developing standardized processes for documenting care efficiently and effectively to protect you in the event of an audit and ensure accurate reimbursement. Some medical billing solutions such as FDS MEDBILL Clinical offer built-in clinical documentation support to aid pharmacists with this step in the process.

Pay Attention to Claims Reconciliation

It’s not enough just to accurately bill for the clinical care services you provide. If you really want to excel in pharmacy medical billing and protect your business’s cash flow, you can’t forget about claims reconciliation. No business can afford to leave money sitting on the table, which is why pharmacy claims reconciliation is so vital to long-term sustainability.

You can get started by developing a dedicated claims reconciliation process—supported by technology—to identify outstanding receivables, find missing money, increase your reimbursements, and reduce the time between check receipt and claims removal, ultimately improving your pharmacy’s cash flow and profitability. Plus, every minute spent chasing missing payments is one that could be better spent taking care of patients.

Keep Current on New Medical Billing Changes

Medical billing (and really healthcare in general) is an ever-evolving space that requires pharmacists to stay up to date on the latest developments. For example, the COVID-19 pandemic introduced several new tracking and billing coding standards as well as new processes and requirements that were all initially foreign to pharmacists and other healthcare providers.

Now facing issues with COVID-19 vaccine billing, the importance of keeping up with pharmacy medical billing changes as things evolve and new clinical care opportunities present themselves is more apparent than ever before. Even with experts stating independent pharmacies are well-positioned to vaccinate their communities against COVID-19, the associated challenges are still a reality.

Some medical billing tools utilize system alerts to help pharmacists and pharmacy technicians keep current on the latest changes in the industry. Additionally, software can flag billing and coding errors to reduce claim denials and payment delays as pharmacists and technicians become more familiar with medical billing and reimbursement.

Utilize a Pharmacy Medical Billing Solution

Like many other areas of your business, technology is available to introduce efficiencies, work behind the scenes, and help you protect the health of your pharmacy at all costs. A medical billing solution such as FDS MEDBILL can ease the administrative burden and reduce unnecessary hassles that make it difficult to get paid on time and in full. 

Make use of software to eliminate potentially costly errors, streamline internal workflows, aid in training exercises, and optimize your pharmacy’s medical billing as a whole. When evaluating different medical billing solutions, make sure you choose a vendor that offers the right must-have features, especially in the wake of the COVID-19 pandemic when the landscape is always changing. Pharmacy medical billing software with the right features will help you improve both your patient care and your business at the same time. 

Your pharmacy’s medical billing solution should have the ability to:

  • Integrate with your existing pharmacy management system (PMS)
  • Optimize reimbursements for clinical care services and supplies
  • Automate medical claims submission, including secondary billing
  • Provide access to claims status, responses, and management queues
  • Alert pharmacists to the latest medical billing and coding regulations
  • Offer extensive point-of-care education and training programs 
  • Generate robust reports using comprehensive data and analytics

Armed with these tips and tricks and a comprehensive pharmacy medical billing solution with all the features you need to guide the way, you can maximize your clinical care opportunities and ensure you’re paid fairly and efficiently for the services you provide.

Ready to get started? Get a firsthand look at FDS MEDBILL to see for yourself how you can transform your patient care and your business as a whole with a medical billing solution designed for independent pharmacies.

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