Difference Between Medical Billing And Pharmacy Billing

1
Difference Between Medical Billing And Pharmacy
Billing
2
Difference Between Medical Billing And Pharmacy
Billing
It has been widely observed that nowadays
pharmacists have an expanded scope of practice by
incorporating more clinical aspects into routine
patient care like chronic disease management,
care transitions interventions, and medication
therapy management. For these clinical services
to be sustainable, pharmacists must be able to
receive payment for the resources and time
dedicated to improving patient care and outcomes.
However, this could be challenging for
pharmacists as there is a lot of difference
between medical billing and pharmacy
billing. Lets understand this difference in
more detail- The difference in Billing format If
you are a pharmacist and looking to expand
pharmacy offerings by trying to bill the medical
benefit then you should know about the difference
in billing formats. Only prescription numbers and
National Drug Codes (NDC) is used for billing
third-party payers for prescriptions while
medical billing uses a different set of codes
such as CPT, HCPCS. Therefore, to bill the
medical benefit of their patients insurance
plans knowledge of medical billing codes is
important for pharmacists.
3
Difference Between Medical Billing And Pharmacy
Billing
Longer Billing timeline for reimbursement The
billing timeline for pharmacy billing is much
shorter as compared to medical billing. When a
pharmacist bills for prescriptions through a
pharmacy benefits manager (PBM), they deny or
approve your claims almost instantly. On the
other hand, billing for medical benefit claims
can often take up to 14 days after you submit
them. Moreover, claim denial may be an additional
headache as you need to resubmit the denied
claims and it can take weeks or months to get
paid for your services. Thats why its so
important to submit clean claims and if you find
it difficult then you can outsource your billing
like us because we have a 95 of clean claim
submission rate. Complex claim submission As we
have already seen that PBM can instantly accept
or denied claims and prescription claims are
almost always approved as long as a medication is
prescribed by a physician and drug is on the
formulary of the patients insurance plan.
However, billing the medical benefit is a
completely different ballgame here you need to
manage several medical billing policies that can
complicate the process, including providing all
the proper documentation of the service you
provided. This is why it is always advisable to
have the assistance of a medical billing solution
to help you submit claims and avoid costly
rejections.
4
Difference Between Medical Billing And Pharmacy
Billing
Use of Medical Billing Solutions Medical billing
is a complex and time-consuming process if you do
it manually as well as it will prone to error
resulting in claim denials. Hence it is feasible
to use medical billing solutions or outsource
your billing to save your precious time and
reduce the risk of claim denials. Finally, we
can conclude that due to falling reimbursements
and rise of DIR fees pharmacists are beginning to
provide clinical care services for their patients
however these challenging task can easily be
handled if you keep in my mind these differences.
If you are not ready to handle such a complicated
billing process, you can completely rely upon us,
we are one of the best medical billing service
providers in the US with extensive experience in
the industry. Are You Ready to Get Billing? Want
to hire an experts in Pharmacy billing and coding
for your practice? You are at the right place,
what you need now is a partner who can finish out
the rest of the work and make the technology and
implementation just as simple. Thats what the
best medical billing company like Medisys Data
Solutions Inc. can do. If youre ready to get
started, schedule a meeting with our medical
billing manager from filling out enquiry form
from our website!
5
(No Transcript)