Pharmacy billing services can be highly crucial than other medical specialty services because it is unique but at the same time, common to other healthcare departments as well. Dealing with claim denials for pharmacy has its utmost complexity. But there are high quality medical billing services providing company that ensures continuous follow-ups of existing and pending accounts receivables and provide exceptional denial management services to your pharmacy.
How A/R follow ups & denial management services help improve your Pharmacy billing services?
The accounts receivable follow-up team in a healthcare organization deals with denied claims and Rather than going with the in-house billing, many pharmacies attached to healthcare practices outsource their medical billing services for better results. Let us take a look at how pharmacy claim submission works.
When pharmacy claims are submitted, the transmission happens through a switch vendor who ensures the transmitted information to adhere to the guidelines of the National Council for Prescription Drug Programs before it reaches the Pharmacy Benefit Manager. For rejected submissions, the pharmacy or the prescriber should effectively communicate the PMB or the third-party payer to get approval.
What are the basic reasons for declined claims?
- Improper insurance information
- Refilling stock too early
- Inappropriate days of supply
- Incorrect/untrue quantity
- Non-covered medication that needs pre-authorization
Improper insurance information can be overcome by enabling accurate and timely verification of benefits before your pharmacy initiates in-house billing. This requires extreme and instant communication with the insurance payer and the same to be communicated to patients who claim for reimbursements.
If there is a possibility to claim non-covered medication, your pharmacy practice should advance in attaining pre-authorization from the respective paying authorities or from the council and make sure proper information is passed on to patients.
The rules followed by insurance payers such as Medicare, Medicaid, or any other private insurance may constantly incur changes. Therefore, to update knowledge instantaneously and make sure the claims submitted are not denied, it is viable to make regular A/R follow-up.
An expert medical billing company like 24/7 Medical Billing Services is highly capable of making your pharmacy billing way easy for you, with highly focusing on your pending and current accounts receivables and making sure that all your claims are reimbursed on time at reduced denial rates. No specialty finds it easy to overcome medical billing woes, in which pharmacy is not least. If you require any help in managing your pharmacy claim denials, we have experts who have served several clients and improved their revenue. Contact us at +1-888-522-0537 for a free consultation.
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