Pharmacy is a crucial component of healthcare, and like other healthcare specialties, it presents some billing difficulties that are frequently challenging to handle internally. Furthermore, experts may be needed to determine the effectiveness of billing for either incorporating or eliminating the pharmaceuticals due to certain medications’ exclusion from insurance coverage and the limited number of injections and adjuvant therapies that are permitted.

Pharmacy-related payments necessitate various levels of data handling and follow-ups, as is typically the case, which further complicates issues. Claims are prepared and submitted jointly by hospitals and nursing homes even if the services are distinct medical services from a different facility and are either supplied later in the care chain or comprise a minor portion of the care services that hospitals offer. There is a higher chance of incorrect data processing and rejected claims as a result of this collaborative claim preparation and submission.

Pharmacy claims are different from hospital claims, but they are nonetheless governed by the same HIPAA regulations, which can make it challenging to deal with when a claim needs to be resubmitted because it violates privacy or security standards.

Because of these inherent difficulties, a number of administrative and data-related tasks must be completed accurately, from verification to claim preparation to submission.

Billing is outsourced to PBC

In addition to accurately assisting you in determining which treatments fall under the category of injectables or adjuvant therapies, PBC Pharmacy’s medical billing and coding services will handle all of your administrative tasks, from thorough claim preparation and submission to post-submission follow-ups and audits in the event that the insurer overpays. This will improve your financial situation and free up more time for you to focus on your primary business, which is pharmacy dispensing.

We offer radio pharmacy, home care, and clinical services to meet the needs of all kinds of clients.

• clinical

These treatments frequently fall under bundled payment modules, which could need managing non-clinical paperwork. We carefully handle every paper trail that accumulates in relation to insurance claims.

• In-Home Care

Injectables are prepared and delivered to home-bound patients; these services are covered by Medicare Prescription Drug Improvement and Modernization (MPDIM). As part of their itinerant schedule, which requires extensive travel to patients’ homes, you will need to prepare and maintain details and perform data handling that is outside of your core competency. We offer a wide network of professionals in every US state as well as experience managing the invoicing process for home care services.

• Coordinated Care

Like clinical services, these are frequently run by large hospitals and assisted living facilities, which receive payment through a bundled payment approach. Maintaining non-clinical documentation and generating reports is necessary for this, which takes time away from spending with patients and exposes them to data and procedural errors that frequently negatively impact their performance as employees of these facilities. You can spend more time administering medications because our end-to-end billing and coding services relieve you of the burden of keeping up with your non-clinical documentation.

• Radio

These services, which are among the most well-known adjuvant therapy services, fall within the Medicare Prescription Drug Improvement and Modernization Act’s (MPDIM) insurance coverage and call for help with billing and coding. Through effective data processing, bill filing, and follow-ups, our medical and billing and coding services have assisted numerous radio drug service providers in improving their financial situation.