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Why You Should Never Outsource Medical Billing

Medical billing is a complex challenge with a steep learning curve for most independent pharmacists—especially for those who are still new to offering patient care services. That said, it’s also a requirement for those who wish to offer patient care services and sell or rent durable medical equipment (DME).

New Era Pharmacists provide patient care services and understand how to be compensated accordingly. As such, the pharmacist role has evolved significantly in recent years, with many becoming trusted caregivers in their communities. Amid the COVID-19 pandemic, pharmacists have taken on even more clinical responsibilities, stepping up to the plate to offer point-of-care COVID-19 testing.

However, new opportunities present new challenges, and for many pharmacists new to offering clinical care services, optimizing medical reimbursement is a continuous struggle. Pharmacists have two options when it comes to medical billing: to manage in-house or to outsource. Here’s why you should never outsource your medical billing, and what you should do instead to ensure you’re paid in full and on time, every time.

Pitfalls and Problems with Outsourcing Medical Billing

If you’re trying to decide the best route to efficient, error-free medical billing for your independent pharmacy, it may be tempting to outsource the entire process. Why not leave it to the experts, right? Nope, wrong! Truth be told, you should never outsource medical billing for a whole host of reasons.

Hidden fees

Sometimes, medical billing contracts have hidden fees baked in that can come as an unwelcome surprise if you’re unaware starting out. Although we don’t recommend outsourcing your medical billing, if you choose to do so, it’s imperative you read your contract very carefully to check for added fees that can cut into your revenue and hinder your pharmacy’s profitability.

Variable cost

When you outsource your medical billing, in most cases, the more you earn, the more you’ll pay. Because of this, the cost can be difficult to determine and plan for accordingly, as cash flows often vary significantly from month-to-month. For example, you’ll likely pay more for outsourced medical billing services during flu season due to an increase in the number of immunizations you administer.

Lack of autonomy

While the idea of handing over your medical billing for someone else to deal with may be appealing, lack of autonomy and the ability to oversee billing processes can actually be very difficult. This is especially true for the more hands-on independent pharmacists, who may have a difficult time fully relinquishing control of the medical billing process to a third party medical billing company.

Wondering what you should do instead of outsourcing your pharmacy’s medical billing? Rather than fully turning your medical billing over and risking concerns regarding cost and control, consider investing in technology to manage claims submission in-house, minus the administrative burden. Next, we’ll talk about how your pharmacy business can benefit from utilizing modern digital solutions.

Why You Should Invest in Medical Billing Technology

Independent pharmacists can benefit greatly from investing in medical billing solutions to manage their claims submission in-house. Using medical billing technology that’s designed specifically for independent pharmacies, such as FDS MEDBILL, you can accomplish the following:

Optimize medical reimbursements

Medical reimbursement continuously proves to be a major pain point for pharmacies—especially for independent stores that lack corporate support and resources. Fortunately, using a medical billing solution, you can streamline and optimize your medical reimbursements, increase your pharmacy’s cash flow, and ensure you’re paid appropriately for the patient care services you deliver.

Offer enhanced patient care services

Helping and caring for patients is why you got into the business in the first place—not to be a pill counter or a number cruncher. With software to guide you through medical claims submission, you can offer a myriad of clinical care services for patients, without worrying about getting paid. That means you’ll gain the ability to offer services like immunizations, diagnostic screenings, chronic disease prevention and management, and more, offering greater care for your patients and your community.

Streamline medical billing workflows

Prescription billing is relatively straightforward for most independent pharmacists; however, the world of medical billing is a totally different beast, with a massive learning curve for most pharmacists who aren’t familiar with the process. Medical billing technology for pharmacies enables staff to automate time-intensive tasks, streamlining workflows and freeing up time to spend with patients.

Reduce billing errors and claim denials

Manual, error-prone medical billing workflows have a tendency to result in unnecessary claim denials and delayed reimbursement. Denied claims not only impede your cash flow, but they also require you to track claims, correct errors, and appeal denials as necessary—all which can hinder your productivity and take away from your other responsibilities.

Using Modern Technology to Optimize Medical Billing

Modern medical billing tools are designed with an array of helpful features, which enable independent pharmacists to:

  • Get electronic eligibility verification to streamline workflows
  • Track refills, rentals, secondary, and held medical claims
  • Automatically set rates to ensure accurate medical billing
  • Review claims status and management through queues
  • See explanation of benefits tracking and repository, and more

Additionally, digital solutions like FDS MEDBILL often offer different levels of service, allowing pharmacists to customize their experience based on their unique medical billing needs. FDS MEDBILL customers can level up with premium services like dedicated claims reconciliation, clinical documentation support, point-of-care education (such as training for COVID-19 testing), and more.

By going this route instead of fully outsourcing your medical billing services, you can gain more in-depth support without breaking the bank or relinquishing control to a third party. Instead, you can make smart use of modern medical billing solutions to maintain full control over your business finances, drive operational efficiencies, and ensure you always get paid for the clinical care services that you provide for your patients, both as accurately and efficiently as possible.

Curious about medical billing technology and how it can help you optimize your medical reimbursements? Schedule a demo to learn more about FDS MEDBILL.



Amplicare is now part of EnlivenHealth®


FDSRX is now part of EnlivenHealth®