10 Common Blunders of Pharmacy Billing
                     10 COMMON BLUNDERS OF PHARMACY BILLING
Pharmacy Medical billing errors are prevalent in practices and can 
be easily made. But, they do have repercussions on the overall 
profit of a healthcare organization. The American Medical 
Association states that errors in medical coding fall under the broad 
category of fraud and abuse. So said, the former means “intentional 
misrepresentation” and later is “the falsification was an innocent 
mistake.”
Medical coding and pharmacy billing are complicated processes that 
depend on the patient, insurer, and procedures. Even the most 
honest financial departments experience claim denials. But knowing 
these blunders beforehand can help you take steps to avoid them.
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[email protected]         https://www.247medicalbillingservices.com/          888-502-0537
Here are the ten most common blunders in pharmacy billing. 
Invalid prescription
Pharmacy benefit managers have access to your prescription claims to identify 
the claims that don’t meet legal regulatory or industry-established standards. 
One of the top reasons where pharmacy claims are denied is an invalid 
prescription. 
Federal and state decide what constitutes a valid prescription. E.g., an invalid 
medication will be if there is a missing prescriber’s signature, drug quantity, 
dates, or missing patient information.
Incorrect prescription refills
If there were some blunders on managing supply on the previous fill, it could lead 
to a prescription refilled sooner than average regulated amounts, which is an 
immediate warning sign. 
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• Incorrect NPI to DEA number
A prescription must match NPI and DEA as a prescriber identification 
number on the claim. 
• Incorrect quantity of a supply
Days of supply and number of refills are also essential factors for 
submitting the correct quantity. Errors happen when pharmacists fail to be 
vigilant on the prescribed dosages, which can cause massive pharmacy 
billing blunder causing claim denials.
• Incorrect supply management
For pharmacies, it is tough to calculate days of supply, specifically if the 
prescription has a complicated dosing routine. As a result, blunders 
commonly happen while entering the proper claim for ophthalmic/otic, 
inhaled, vaginal, and topical products, as it is hard to pin down the right 
amount of dose or supply.
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Incorrect procedure codes
If you are receiving claims back more frequently, there might be an incorrect 
input of codes. A mistyping blunder can cause to have the wrong code in the 
system. It can also happen if a document is incorrectly coded and submitted 
to the medical billing department.
There is also a slight chance of human error where a staff member doesn’t 
follow the correct coding procedure. In such cases, it is crucial to provide 
necessary training to the staff to avoid such blunders. 
A claim is missing information.
The most common missing factors that cause denials are a)date of a medical 
emergency, b)date of the accident, and c) onset date. Therefore, it is crucial 
to check for these missing fields with proper documentation.
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Upcoding
Upcoding occurs when patients are being billed for more procedures 
than they receive. It can also happen when medical bills are 
submitted for the procedures that weren’t done in the first place.
Upcoding also happens if the medical billing department makes a 
mistake when entering wrong treatment codes or a physician fails to 
provide accurate information.
Claim not filed on time
If a claim is not filed within a given period, it might result in a denial. 
Therefore, healthcare providers and medical billing services should 
be aware that they must submit the claims within 12 months of 
duration.
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Mishandled payments
One of the common errors in medical billing is when the payer has over 
or underpaid, leading to claim denial. Either the case, should rectify this 
error quickly and should process interest payments correctly.
Conclusion: To ensure your practice has long-lasting success, you have 
to optimize your billing efforts. It is essential to eliminate the most 
common medical billing mistakes and develop strategies to prevent 
them from impacting your revenue cycle. 
One of the best methods to remove such blunders is to outsource 
medical billing services. At 24/7 Medical Billing Services, we help 
practices increase their revenues by reducing claim denial rates. Learn 
more from our experts; book a free consultation today!
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ABOUT US
• We are a medical billing company that offers ‘24/7 Medical Billing Services’ and 
support physicians, hospitals, medical institutions and group practices with our end to 
end medical billing solutions. We help you earn more revenue with our quick and 
affordable services. Our customized Revenue Cycle Management (RCM) solutions 
allow physicians to attract additional revenue and reduce administrative burden or 
losses.
• Our company was founded in 2005 and is now a leading organization of highly 
motivated and certified coders & billers in the US medical billing industry. Our current 
employee strength is 500+ and we have ambitious plans to grow more rapidly.
• As a leading Medical Billing Outsourcing Company we take care of the complete setup 
& enrolment in about one to four weeks time depending on the complexity of the 
project. We have certified trainers with 10+ years of experience to train the 
newcomers so they can get acquainted with the specialty jargons & stay updated with 
the recent coding developments.
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CONTACT US
24/7 Medical Billing Services
16192 Coastal Hwy,
Lewes, DE – 19958
USA
Phone no : 
+1 888-502-0537
Email Address :
[email protected] 
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