Boost Your Revenue: Essential Tips for Specialty Pharmacy Billing

Today, specialty pharmacies play a vital role in critical patients’ lives as they provide medications for treating rare or complex health problems. Being a complex practice by itself, managing a seamless specialty pharmacy billing practice is still a struggle for many specialty pharmacies. The fast-evolving landscape of specialty pharmacy billing makes it more difficult for practices to adopt such changes efficiently. Still, as an owner of a specialty pharmacy, you can improve your billing practice while maintaining a healthy stream of revenue by streamlining the following practices-

Effective practices to augment the specialty pharmacy billing revenue-

1) Detailed documentation:

Accurate documentation plays a vital role in amplifying your overall practice revenue. From documenting accurate patient information to the medical necessity of rendered specialty drugs, the overall process requires detailed documentation. Make sure that you thoroughly review all documents to avoid any potential error in the specialty pharmacy billing process.

2) Improve insurance verification and prior authorization:

The insurance verification process involves verifying a patient’s identification, insurance ID, length of coverage, policy numbers and other nitty-gritty details. To avoid any waiting period, the patient information must be current and accurate. This step enables you to avoid claim rejections and patient dissatisfaction. Also, there are specialty pharmacy drugs that require you to get prior authorization from a patient’s insurance company before administering them. The truth is that prior authorization is a time-consuming process; therefore, you need to make prompt prior authorization requests to your patient’s insurance company.

3) Streamline the billing and coding process:

You can leverage Standard Operating Procedures (SOPs) to streamline the perfect coding and billing practice in your specialty billing. By implementing this strategy, you can ensure that your in-house staff follows the same efficient process for handling specialty coding and billing. Specialty pharmacy codes are updated frequently, and each payer has their own set of guidelines. Therefore, you should train and educate your staff with the latest specialty billing coding and billing guidelines.

4) Implement efficient denial management:

Claim denials are the main cause of poor cash flow, increased number of Accounts receivable and revenue leakage for many specialty pharmacies. There could be multiple reasons behind claim denials. Your in-house denial management team should know all the potential reasons behind claim denials and how to correct those mistakes. Make sure the denial management team follows up with insurance companies about the claim status to ensure timely payments.

To ensure a faster and more profitable ROI, many specialty pharmacies are turning to outsourcing instead of handling billing in-house. This is because dedicated outsourced billing professionals can manage the complexities of specialty pharmacy billing much better than regular, inadequately trained staff.

If you are looking for a perfect specialty pharmacy billing partner, Sunknowledge could be your ideal destination. For over 15 years, Sunknowledge has been the top outsourced billing partner for leading names in the specialty pharmacy industry, handling all pre- and post-billing services. From documentation and coding to timely claims submission and overall billing management, Sunknowledge focuses on improving your ROI with high accuracy and productivity.