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Difference Between Medical Billing And Pharmacy Billing

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.

Let’s 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.

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. That’s why it’s 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 patient’s 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.

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. That’s what the best medical billing company like Medisys Data Solutions Inc. can do. If you’re ready to get started, schedule a meeting with our medical billing manager from filling out enquiry form from our website!

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