How do the Specialty Pharmacy Billing Companies Tackle Reimbursement Delays?

Specialty pharmacies mainly deal with high-cost medications. The insurers carefully review every claim using the exact codes and patient notes. Always remember that even a small error can keep the payment in the loop for weeks or even months, thus causing issues in cash flow and more administrative burden for your team.

That's why the requirement for quicker reimbursement comes in. It helps the pharmacies to focus on patient support. The specialty pharmacy billing companies come with dedicated experts who help in faster reimbursements. So, let's dive into the problems that occur due to reimbursement delays and then how these outsourced companies help with this.

Problems with Reimbursement Delays

Mistakes in coding and documentation process

You always need to ensure comprehensive documentation and precise coding process for billing your specialty drugs. You can always face claim denials because of assigning wrong NDC qualifier and always appeal each rejection with accurate details.

Challenges of Benefit Verification

It is very difficult to verify patient benefits for specialty drugs. The insurance plans differ by copy and eligibility rules.

Prior Authorization Challenges

Prior authorization is a very complex process due to varying payer rules. Apart from that, it is also a time-consuming process as the staff needs to gather clinical documentation and complete long forms to make sure no PA denial occurs.

Insurance Review Times

Insurers take a lot of time to review specialty drug claims. They check all the codes, benefits, and documentation for different plans. This process can take even weeks, which leads to delayed payment. Hence, it impacts the clinic's cash flow, which also leads to reduced patient care.

How the Specialty Pharmacy Billing Companies Tackle Reimbursement Delays

Managing Patient Records

Professional billing experts always know what it takes to create proper patient records so that you can receive timely reimbursements, thus enjoying your practice to enjoy excellent cash flow.

Creating Patient Demographic Entries

These specialty pharmacy billing companies collect and enter all the necessary patient details. These include patient name, age, diagnostic reports, medication history, previous prescriptions, and any other data required.

Prior Authorization

Prior authorization is very complex and time-consuming for the healthcare staff to manage. These outsourced experts verify patient insurance eligibility, collect important documents, and then submit PA requests to make sure no claim denial occurs.

Refill Management

The companies have a highly structured refill management process for their customers. Hence, the best pharmacy billing experts make sure that all necessary reminders and approvals are set up so that if anyone comes for a refill, the process is taken care of without any delay.

Payment Posting

The important aspect of a specialty pharmacy is finding the best approach for reconciliation. These experts streamline the entire manual posting work by automatically posting all received payments and reducing the time spent on data entry.

Why There's This Growing Demand for Specialty Pharmacy Billing Companies?

The US healthcare industry is constantly changing. That's why the healthcare staff are facing issues staying updated with the changing regulations as they have other important tasks to do. So, the solution to this problem is to simply outsource specialty pharmacy billing companies.

These experts provide a full range of pre and post-billing solutions, which include insurance verification and demographic entry, prior authorization, charge Entry, documentation, EMR update, coding and claim submissions, and denial management & accounts receivable collections. Moreover, these companies can reduce your operational costs by 80%, and they have dedicated resources working in real-time across all time zones. Moreover, they don't have any binding contracts or restrictive clauses.