7 Tips to Ensure Success in Pharmacy Billing with Altering Healthcare

It is difficult to sustain in a constantly altering healthcare industry and avoid losses.With the ever-changing healthcare industry and a rapidly growing relationship between physicians and pharmacists that is creating an influx of patients for both the professionals, pharmacists are becoming busier by the day; as more and more patients are taking help from pharmacists in not only asking prescription related queries, but also inquiring and interacting with them on diet/lifestyle changes. Hence, pharmacists today need to focus on the foremost and toughest things which is accounting and bookkeeping. Here are some tips that can ensure success in pharmacy billing: 1. NCPDP sign up: Pharmacists must sign up with the database service of National Council for Prescription Drug Programs (NCPDP) which permits a pharmacy to bill. A six-digit number is provided to all pharmacies, known as the BIN, which is used for identification. 2. Insurance billing: Pharmacists must keep a 3rd party cheat sheet book. This should have a list of pharmacists who can be of help when required; should contain the state Medicaid’s BIN number; and must contain the billing procedure of test strips for Medicare Part B etc.). 3. Third Party Relationships and contracts: Insurance agencies have a third party known as the Pharmacy Benefit Manager (PBM), e.g. Medco and Express Scripts. These perform the complete auditing and verification of the prescription billed for the insurance company. Also, signing contracts is imperative. A pharmacy cannot bill to PBM unless a contract has been signed (by the third party) as this contract allocates the co-pays etc. to the pharmacy. Apply for insurance contracts (associate with local pharmacy groups and then with contracts via that group) and start billing with the complete details of the prescription and the patient’s demographics.

4. Technology: Pharmacists must use the latest pharmacy billing software – QS1. And must always verify in case of doubt (e.g. if a certain drug is reimbursable or not) with the insurance agency. The latest technology ensures a smooth and flawless billing process. 5. Financials: For financial reliability, ensure that the co-pay and amount reimbursed by the insurance agency are equal to the amount billed. Make certain that patients are aware of the cost of services, and that they are responsible for its payment if the insurance payer does not reimburse. Maintain a document of each patient and the services provided. 6. Web claims: For web claims, pharmacists must ensure they have a personal identification number (PIN) from Division of Medical Assistance Programs (DMAP) for Medicaid services. Web claims must not be submitted if hard copies need to be attached, or claims are being filed more than a year after the date of service. 7. NPI number and codes: Obtain a National Provider Identifier number. This is especially useful if the billing for clinical services by pharmacists has to be done via a physician’s office. Pharmacists needs to be aware of CPT codes which are specific to MTM (Medication Therapy Management) services provided by them (Medicare Part D payers compensate MTM services for entitled patients). Create a standard process for all patients for delivering utmost care and wellness eventually leading to a resourceful practice and hence succeeding in a competitive environment. Thus, with a smooth pharmacy billing process in place, there will be higher reimbursements and more profits.

How to Improve Medical Practice Collection and Decrease Account Receivable Days

Revenue cycle management is one of the key requirements for improving and properly managing the medical practice collection. Apart from adopting different ways to decrease the accounts receivables days and improving medical practice collection, creating medical billing reports and understanding the general rules pertaining to the process of billing and account receivables are also imperative. These reports give a lucid view of how a medical practice is performing on vital revenue cycle metrics, how well are the physicians being paid by the insurance carriers for the key procedures, and whether the claims are being paid in a time-efficient ways.

Here are some vital reports which you must indulge in creating and regularly running managing the accounts receivables:

Accounts Receivables Aging Reports

The Accounts Receivable Aging Report (AR aging report)is a great barometer for the determining the health of an average practice. By simply looking at this report, an experienced medical biller can tell you whether the billing department of the medical practice is doing a great job or not. This report breaks down the claims on the basis of the number of days they have been in the receivables, that is, the number of days they remained unpaid.

This report also aids in identifying the potential issues from a broader view, while the follow-up reports helps in presenting a close-up look about where the different issues might be stemming from.

Key Performance Indicators Report

The KPI (Key Performance Indicators) Report provides a broader view of the key areas in the revenue cycle management process of your practice, allowing the identification of the trends and changes, and spot the various potential problem areas. It is an extremely valuable report that helps you identify which CPT codes and encounters can be highly profitable for your business.

General Rule for Accounts Receivables regulations

As a general rule, it is said that the monthly Accounts Receivables must not exceed 1.5 times the monthly charges. Thus, it is a highly effective way for gauging how your billing company is performing and how it is operating. If you find that your accounts receivable exceed this calculation, it is the right time you execute a detail execution.The next area which you must look at is your Accounts Receivables organized by the insurance class. It is very important to see and check how you are being paid by the insurance companies, and if these timelines are exceeding than what you signed in the contract, it’s time to work out on this issue with the insurance companies. physicians are offered great support and help pertaining to all the billing and coding processes in the medical centre. The Medical Billers and Coders update the medical practitioners and physicians about all the latest trends and help them manage their accounts receivables for decreasing the accounts receivable days and improving medical practice collections.

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