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Pharmacy Billing Challenges

Pharmacy Billing Challenges

Challenges in pharmacy billing are affect the pharmacy revenue flow. Rapid changes in healthcare and increased demands in healthcare, pharmacies too are facing the effects. There are multiple barriers are keeping them from maintaining smooth revenue flow. Challenges in billing significantly impact the bottom line, though a host of other challenges exist that can impact pharmacy reimbursement. The main focus of pharmacies should be patient care. Here you go, you can outsource your pharmacy billing to us and you can focus on what you are special in.

Top Pharmacy Billing Challenges:

Documentation Challenges in Pharmacy

Pharmacists may not sufficiently document codes for drugs while doing pharmacy billing.


Roles and responsibilities of the pharmacy staff might not decide properly while doing pharmacy billing.

Updates in healthcare industry

Your staff may not have access or the resources for updated information and training on various drugs and their revised codes.

Your staff also need to be aware about maximum dosage requirements of the drugs. Your software as well as your revenue cycle process should be updated with the latest U.S. governments rules and codes for various drugs.

Patient Satisfaction

Pharmacy vigilance department continually update information about allergies caused by various drugs. Your medical billing team may not be aware of this updated information may cause claim denials and revenue loss. This may lead to poor patient satisfaction and practice loss as well. Low quality of patient service also could result in poor patient satisfaction.


The pharmacy billing system may not flexible. Medical billing may not process vaccine claims covered by pharmacy or medical benefits.

Frequent Claim Denials

Frequent claims denials because of missing information, lack of updated patient information, eligibility issue, lack of drug codes or wrong medical codes. This could lead to major loss of revenue of your pharmacy billing.

Incorrect payment posting in Pharmacy Billing

Incorrect payment posting may lead to wrong A/R calculation. This happen because of error in submission of data. Ultimately wrong payment posting affect on revenue and budget planning.

Insurance Coverage in Pharmacy Billing

Your team may not be aware of the covered set of drugs, injections and therapies. Experts may need to assess if its worth including or excluding them during medical billing. We cover insurance coverage in patient eligibility step which remove this issue.

Underpayment and Scalability

Your pharmacy billing system may not be scalable. Wrong charge description master (CDM) may result in underpayment, claims denials and penalties.

Staff Availability

Shortage of work force may lead to wastage utilization of time and energy while doing pharmacy billing, especially when serious cases need to be managed.

Less Access

Patient’s eligibility access might not available at the time of service to your staff.

To work seamlessly, reach out to our updated and trained pharmacy billing staff to outsource your billing. Our billing team is updated with information about government rules and regulations and drug codes, should be incorporated in the billing process. We regularly train our staff so that our clients may not face any unnecessary claim denials. We provide complete revenue cycle management solutions to ensure client satisfaction.

Are You Ready to Get Billing?

Want to have an error-free billing and coding expert at your work? 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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