3 Essential Must haves for Pharmacy Billing
Medical billing is a vital part of a practice offering point of care services. This article will look at 5 essential must-haves for practices interested in pharmacy billing.
Knowledge of State Laws
Knowing state laws is a must-have when a pharmacy is adding billing into its system. Although laws allow new collaborative efforts between pharmacists and physicians to provide services for patients, there are strict rules to adhere to. Certain states allow different medical services but impose strict regulation with different types of collaboration. For instance, a state may not allow interaction between physicians and pharmacists which can lead to a limitation in collaboration.
Billing & Reimbursement
To receive proper credit for providing services, there must be an understanding of billing and reimbursement in place. Knowledge of the billing cycle is vital for any service provider. From the workflow to the procurement of medication, to inventory, supply, and the chargemaster, many different aspects are needed when dealing with pharmacy billing.
The procedures a provider follows are important to their billing cycle as well as minimizing incorrect reporting. Errors in reporting occur when the processes are not uniform for all departments. Pharmacists may be responsible for fixing and errors that occur between drugs ordered and the chargemaster. By implementing a systematic approach, you can increase profit, increase compliance, and make your practice more efficient.
Having a grasp on coding is an important attribute for any pharmacist interested in providing on-site services. Costly damage could arise if drugs do not have appropriate HCPCS coding. This will also lead to errors in the chargemaster and increase the possibility of declined reimbursement.
Pharmacists must also be aware of special coding that is needed when services are being provided in non-institutionalized clinics. Pharmacists can include Medication Therapy Management (MTM) codes or pay for performance (PfP) contract to be incorporated in the billing process. These are necessary to prevent services automatically defaulting to Medicare regulations-which means no reimbursement.
While these three topics are only a fraction of the skillset and understanding that is needed for billing, providers who obtain these basics will be heading in the right direction in the world of in-house services. For more information, head over to Advanced RX, where specialists are available to help create a plan for your practice.