How to claim a faster reimbursement rate in pharmacy billing? - PowerPoint PPT Presentation

View by Category
About This Presentation
Title:

How to claim a faster reimbursement rate in pharmacy billing?

Description:

Among the many processes to claim a faster reimbursement rate in pharmacy billing that could be streamlined through technology, pricing verification, reimbursement accuracy, prescriber and patient dispensing verification along with prior authorization. This not only aides in improving pharmacy claims reimbursement, but your facility will also reap operational benefits. – PowerPoint PPT presentation

Number of Views:1

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: How to claim a faster reimbursement rate in pharmacy billing?


1
  • How to claim a faster reimbursement rate in
    pharmacy billing?

2
How to claim a faster reimbursement rate in
pharmacy billing?
  • Among the many processes to claim a faster
    reimbursement rate in pharmacy billing that could
    be streamlined through technology, pricing
    verification, reimbursement accuracy, prescriber
    and patient dispensing verification along with
    prior authorization. This not only aides in
    improving pharmacy claims reimbursement, but your
    facility will also reap operational benefits.
  • Major factors driving complexity in the pharmacy
    claims process
  • There are three reasons why community pharmacies
    need to improve pharmacy claims management
  • Regulatory compliance
  • The state and federal guidelines governing who
    can prescribe medicines, and who can dispense
    them grow more complex each year. Along with that
    regulatory oversight of drug manufacturers and
    distributors, and the pharmacies face a rising
    compliance challenge.
  • Medication benefits
  • The prescription drug benefits that healthcare
    plans provide are increasing in complexity.
    Pharmacy owners have to navigate benefit tiers,
    various co-payment and co-insurance levels,
    direct and indirect remuneration (DIR) fees,
    prior authorization requirements, and more.

Medical Billing Services in Oregon
3
How to claim a faster reimbursement rate in
pharmacy billing?
  • Reimbursement Rates
  • Health plans continue to lower the reimbursement
    rates for prescription drugs. This downward
    pressure intimidates pharmacy reimbursement
    rates. One way pharmacists can ensure a higher
    reimbursement rates is via a thorough pharmacy
    medical billing and coding professionals.
  • Pharmacy claims management and reimbursement
    functions that should be automated
  • Dispensing Coding
  • The dispense-as-written (DAW) codes tell clearly
    about the healthcare plan of the patient or a
    specific brand-name drug requested by them. If
    the DAW code is entered as a default code, the
    pharmacy may get a lower reimbursement for the
    actual brand-name drug it dispensed.
  • Inventory Management
  • Validate the national drug code (NDC) assigned to
    medicines for which claims were submitted. Most
    often or not, drug manufacturers recycle NDCs,
    which means a code could become obsolete for a
    discontinued drug. The code edit notifies
    pharmacies and the patient of an obsolete NDC,
    and potentially increase reimbursement.

Medical Billing Services in Oregon
4
How to claim a faster reimbursement rate in
pharmacy billing?
Dosage and packaging Always check the pharmacy
claim for a specific medication, its dosage and
the drugs unit-packaging for the drug and its
recommended unit-packaging. Reimbursements for
drugs dispensed with the right dosage and
packaging codes will help your facility to get
reimbursed appropriately. Prior authorization
services Automating this work undertaking or
letting the experts in pharmacy medical billing
and coding streamlines key portions of your claim
reimbursement. Remember that the prescriber and
need prior approval from a health plan to give a
specific medication to a patient. This helps them
to avoid treatment delays and increase customer
satisfaction. By automating the pharmacy
reimbursement claims through technology, and
partnering medical billing and coding
organization pharmacies can put themselves in a
much stronger position to address the main
factors of their business, which is making
pharmacy claims reimbursement a streamlined
process. All in all this combination helps
maximize revenue, expand cash flow and generate
operating efficiencies by reducing billing and
coding errors that derail your income cycle.
Medical Billing Services in Oregon
About PowerShow.com