Benefits of Medical Billing for Prescription Drugs

Touseef Riaz

October 4, 2022

Medical Billing for Prescription Drugs

Medical billing has always remained a significant challenge for pharmacists to make it accurate and compliant for reimbursement purposes. Certain pharmacists always underestimate medical billing for prescription drugs. 

The rate of reimbursements is continuously declining, and DIR fees are rising. To survive in this situation, pharmacists have decided to provide clinical services to patients. However, pharmacists are new to this business and can face particular problems in getting paid. 

Medical Billing for Prescription Drugs

Let’s explore the ins and outs of the pharmacy billing system and compare it with medical billing. 

Medical Billing Vs. Pharmacy Billing:

One of the significant differences between both types of billing is their format. Billing the third-party payers for prescriptions requires the number of prescriptions and National Drug Codes (NDC). 

Medical billing is different compared to pharmacy billing when it comes to the coding system. Pharmacists must go over the Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) to pursue effective billing. 

Pharmacists will also notice a significant difference in medical and pharmacy billing guidelines. When prescriptions are billed through the pharmacy, the claims are denied or approved within no time. 

In medical billing, the required time of approval or denial is longer. They demand almost 14 working days to process claims. If your claim is denied, you have to resubmit it, which can take weeks or months to get paid for the rendered services. This is why medical billing documents need to be compiled accurately and precisely. 

Overall, pharmacy billing is relatively easy to submit and get paid compared to medical billing. Most of the time, they are approved as long as the physicians prescribe them. 

However, medical billing is different as you have to follow specific guidelines and policies, which is a complicated process. Moreover, there is no margin for mistakes in the medical billing process. Therefore, it’s essential to take the services of a trustworthy and authentic medical billing company. 

 Hospitals and clinics have their team of medical billing experts, or they outsource their billing and coding services. Conversely, most pharmacies have to bill without the help of experienced experts. 

In such a scenario, the best approach for pharmacies is to outsource their pharmacy billing services to experts. So now you should be thinking of how hiring these experts can make the job easy for your pharmacy. 

Let’s explore the benefits of hiring pharmacy billing experts. 

Outsourcing Medical Billing for Prescription Drugs:

Outsourcing your pharmacy billing keeps you away from several hazardous problems. Listed below are some major pharmacy billing issues that a trusted billing partner can quickly resolve. 

  • Audit possibility 

If you have committed too many errors in your pharmacy medical billing, the audit team will knock on your door. Check your medical billing documents strictly, and then identify any flaws before letting them find them. 

If you are guilty of what you have done, you will have to face severe consequences in the form of massive fines and cancellation of your payer contracts. So, in order to control the situation, you must have control of your overall medical billing process. Otherwise, you have to face those consequences, which will be expensive in your pockets.

  • Account receivable aging 

 Almost all pharmacies face AR aging issues. In fact, this practice is prevalent in nearly all infusion pharmacies. It highlights that when your oldest accounts reach the duration of 90 days old, they automatically change into write-offs. If your oldest account numbers are increasing, you can face severe consequences in the future.

It’s hard to know that there is no proper strategy to tackle this problem. When your account receivable requires a lot of attention, you don’t have enough resources to implement a suitable strategy that can recover you from this danger. 

Pharmacy medical billing experts can help you by regularly checking your account receivable age so you don’t face any challenges. 

  • Shortage of experienced billers 

Another common issue that pharmacies face is the lack of staff, due to which they are forced to hire a less experienced team of billers. Unfortunately, the cost of hiring less experienced billers is massive. In addition, if you have hired an inexperienced biller, you can face problems like incorrect coding, ineffective billing calculations, and many more.

 Most pharmacies believe that having a solid team can control all of these issues, which are easy to overcome. However, they are more likely to commit errors because they have an excessive workload that is complex to handle. 

Outsource your pharmacy medical billing from leading pharmacy medical billing experts who will always make your job easier and effective

  • Healthcare industry updates 

Whether we talk about medical billing or pharmacy billing, the rules and policies in this industry are regularly changing. The Healthcare industry continues to implement new regulations for pharmacists. To be reimbursed, you always have to stay up-to-date on the changing rules of pharmacist billing. For instance, if you put the wrong code of the drug after it is updated, you can face serious problems. Your Billing software should be updated with the current rules that are launched by the Healthcare industry and codes for various drugs.

 If you are running a Pharmacy, you should conduct regular training sessions for your employees to get updated with the recent regulations in the pharmacy medical billing industry. 

The safe side for you is to outsource medical billing for prescription drugs from an experienced pharmacy billing company. They will increase your profits and maximize your reimbursement rate. In addition, they have a keen eye on the changing updates in the Healthcare industry, and they always stay up to date to maximize the chances of reimbursement success. 

In the End: 

Most pharmacies deal with medical billing issues because they either have no relevant experience or have excessive work burdens. As a result, you have two options: outsource your pharmacy billing or select an experienced service provider. Always look for a reliable pharmacy billing provider capable of increasing your reimbursement rates, or you can simply outsource pharmacy billing services from a renowned medical billing company. You can expect the best results from both ways.


How does outsourcing pharmacy billing make the Journey Easy?

Many pharmacies lack experience in dealing with pharmacy billing systems. If any uncertain error is committed, you can face denial in reimbursements or huge fines. 

Pharmacies also face staff shortage problems, due to which they are forced to hire inexperienced billers with a high probability of committing errors. 

Outsourcing your pharmacy billing services from a renowned medical billing company will make your life easy and minimize reimbursement denial rates. Thus, third party pharmacy insurance billing resultantly, you can enjoy healthier profits. 

What is RX billing?

RX is the medical prescription symbol derived from the Latin word “recipe,” which refers to take. 

What should be included in the prescription?

The following elements should be included in the prescription: 

  • Issue Date 
  • Patient address and name 
  • Date of birth 
  • Clinician name 
  • Name of drug 
  • Drug strength 
  • Form of dosage 
  • Quantity prescribed 

What are J codes?

J codes are part of the HCPCS Level II set of procedure codes. Medicare utilizes these codes to recognize injectable drugs that can’t be self-administered. 

What are inscription and subscription in prescription?

The inscription contains the name and ingredients quantity. The subscription refers to the instruction given to the pharmacist in the form of a short sentence like “provide 30 tablets.”

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