7 Tips to Ensure Success in Pharmacy Billing with Altering Healthcare
                     
7 Tips to Ensure Success in Pharmacy Billing with 
Altering Healthcare
It is difficult to sustain in a constantly altering healthcare industry and avoid losses. With the ever-changing 
healthcare industry and a rapidly growing relationship between physicians and pharmacists that is creating an 
influx of patients for both professionals, pharmacists are becoming busier by the day; as more and more 
patients are taking help from pharmacists in not only asking prescription-related queries but also inquiring and 
interacting with them on diet/lifestyle changes. Ensure that your pharmacy earns the revenue you deserve by 
understanding what factors could prevent your pharmacy billing success.
Hence, pharmacists today need to focus on the foremost and toughest things which are accounting and 
bookkeeping. Here are some tips that can ensure success in pharmacy billing:
• NCPDP sign up: Pharmacists must sign up with the database service of the National Council for Prescription 
Drug Programs (NCPDP) which permits a pharmacy to bill. A six-digit number is provided to all pharmacies, 
known as the BIN, which is used for identification.
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7 Tips to Ensure Success in Pharmacy Billing with 
Altering Healthcare
• Insurance billing: Pharmacists must keep a 3rd party cheat sheet book. This should have a list of 
pharmacists who can be of help when required; should contain the state Medicaid’s BIN number; and must 
contain the billing procedure of test strips for Medicare Part B etc.).
• Third-Party Relationships and contracts: Insurance agencies have a third party known as the 
Pharmacy Benefit Manager (PBM), e.g. Medco and Express Scripts. These perform the complete auditing 
and verification of the prescription billed for the insurance company. Also, signing contracts is imperative. A 
pharmacy cannot bill PBM unless a contract has been signed (by the third party) as this contract allocates 
the co-pays etc. to the pharmacy. Apply for insurance contracts (associate with local pharmacy groups and 
then with contracts via that group) and start billing with the complete details of the prescription and the 
patient’s demographics.
• Technology: Pharmacists must use the latest pharmacy billing software – QS1. And must always verify in 
case of doubt (e.g. if a certain drug is reimbursable or not) with the insurance agency. The latest technology 
ensures a smooth and flawless billing process.
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7 Tips to Ensure Success in Pharmacy Billing with 
Altering Healthcare
• Financials: For financial reliability, ensure that the co-pay and amount reimbursed by the insurance agency 
are equal to the amount billed. Make certain that patients are aware of the cost of services, and that they 
are responsible for its payment if the insurance payer does not reimburse. Maintain a document of each 
patient and the services provided.
• Web claims: For web claims, pharmacists must ensure they have a personal identification number (PIN) 
from the Division of Medical Assistance Programs (DMAP) for Medicaid services. Web claims must not be 
submitted if hard copies need to be attached, or claims are being filed more than a year after the date of 
service.
• NPI number and codes: Obtain a National Provider Identifier number. This is especially useful if the 
billing for clinical services by pharmacists has to be done via a physician’s office. Pharmacists need to be 
aware of CPT codes that are specific to MTM (Medication Therapy Management) services provided by 
them (Medicare Part D payers compensate MTM services for entitled patients).
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7 Tips to Ensure Success in Pharmacy Billing with 
Altering Healthcare
Create a standard process for all patients for delivering utmost care and wellness eventually leading to a 
resourceful practice and hence succeeding in a competitive environment. Thus, with a smooth 
pharmacy billing process in place, there will be higher reimbursements and more profits.
About MedicalBillersandCoders
MedicalBillersandCoders (MBC) is a leading medical billing company providing complete revenue cycle 
management services. Our billing and coding experts are well-versed with the latest pharmacy billing updates 
helping you to receive accurate insurance reimbursements. To know more about complete pharmacy billing 
and coding services, contact us at [email protected]/ 888-357-3226
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