How Does a Specialty Pharmacy Billing Company Impacts Patient Care?

Pharmacy medications are useful in treating patients having chronic conditions. The pharmacy stores don’t sell drugs such as aspirin or antibiotics. Instead, they provide expensive and complex medications which are cancer and arthritis drugs. According to the National Association of Specialty Pharmacy (NASP), 68% of patients faced treatment delays because of billing issues. That is why accurate billing is critical for pharmacies otherwise the patients may not get the necessary care on time.

Billing for these drugs is not a simple task. That is why you can outsource a third-party pharmacy billing service that can reduce your billing errors.

Impact of Specialty Pharmacy Billing Company on Patient Care

Faster Access to Medications

Getting specialty drugs to the patients is highly important for the hospitals. However, billing can slow down this process if it's not right. Mistakes in billing, like wrong codes or missing patient information, can seriously lead to claim rejection. That is where the pharmacy billing services speed up the claim submission by properly complying with the HIPAA law.

Avalere Healthcare's report found that 15% of specialty pharmacy bills are rejected on the first attempt. This rejection can delay treatment by several days, even weeks. On the other hand, billing companies have specialized experts who double-check the patient insurance numbers, billing amounts, and drug codes to streamline the claim submission process.

Supporting Patients with Chronic Conditions

The pharmacies struggle to keep up with the large patient volumes. The American Journal of Managed Care report found that 85% of patients having chronic conditions stayed on the same treatment plan even though it needed changing. It also happened because of an improper billing process.

For example, imagine a patient having multiple sclerosis (MS). Their medication costs $6,000 a month. They also need it every 30 days. If billing fails, they might miss a dose. The specialty pharmacy billing company complies with all the CPT and ICD codes to make sure the bill is ready on time.

Lowering Cost for Everyone

A study by the Healthcare Financial Management Association (HFMA) found that specialty pharmacies lose $1.2 million a year on average because of billing errors. On the other hand, the billing companies provide dedicated resources that focus on solving only your billing issues. They also come at a much lower cost compared to the in-house billing team. Hence, the providers can save a massive cost when outsourcing their billing needs to a third-party provider.

They Help with Prior-authorization service

Prior authorization is a very complex process to manage. If the providers use their whole time to solve the prior authorization issues, then they may not get the time to provide quality care to their patients. So, what to do?

Pharmacy billing solutions have experts specialized in solving all the complex nuances of prior authorization. They prepare and submit the required paperwork to insurance companies to streamline the claim submission process. It speeds up approvals, ensuring patients get their medications without long delays.

Final Thoughts

Billing may not seem exciting, but it's a lifeline for pharmacy patients. Here, the experts of the specialty pharmacy billing company are updated with the ever-changing regulations to streamline the billing process.

These companies reduce physicians' stress with their advanced billing software, which reduces billing inaccuracies in a shorter amount of time. So, next time you need help with specialty drug billing, remember that the experts are helping you to thrive, one bill at a time.