Specialty Pharmacy Billing Services
Specialty pharmacies have the task of serving patients with chronic conditions, providing specialty medications for treating rare or any health conditions that are complex. They cater to the specialized requirements of high cost and high touch medication therapy. However, the role of a Specialty Pharmacy extends far beyond just filling the specialty prescription. Owing to the fact that they address the needs of complex therapies, their billing processes are also more complex than those of traditional pharmacies. Increased level of management of patients, specific dosage guidance and counseling are needed to enhance your ROI possibilities.
Here are some important points to ponder.
- One of the worst things that can happen is failing to find the right balance between patients and managing specialty pharmacy billing.
- To manage your reimbursement process effectively, it is critical to have a sound plan in place to efficiently streamline your billing process.
- If you are struggling to manage your practice in an economy where profit margins are steadily shrinking over time and the competition increasing, picking the right Specialty Pharmacy billing company becomes extremely pertinent.
- In recent times, given the growing administrative and managerial challenges in the healthcare sector, Pharmacy billing companies have caught the eyes of specialty pharmacists and related specialists.
Managing Specialty Pharmacy Billing with a Trusted Guide
To ensure a holistic approach to Specialty Pharmacy billing, it is vital to manage efficiently everything from start to finish. Creating the perfect approach demands that you know how to create a perfect support system (or a billing team, if you prefer) that knows how to work in full compliance with CMS Pharmacy billing guidelines.
The need of the hour is in implementing checks and balances with a surefire specialty pharmacy billing and coding services destination. However, given the plethora of RCM companies in operation today, and many of them claiming to be specialists in managing coding, billing and collections for Specialty Pharmacies, it often becomes very difficult to know if you have chosen someone who can genuinely work according to the latest Specialty Pharmacy billing mandates and provide assistance as a reliable operational extension.
Capitalize on Sunknowledge Specialty Pharmacy Billing Solutions
Our ability to serve you with the right purpose and knowledge is what makes us a robust Specialty Pharmacy billing service. We understand how to dive deep and engage with payors, a unique advantage that we enjoy over other RCM companies by dint of our long and direct association with major healthcare insurers in the US.
Moreover, we set the benchmark in such a manner that all your front-desk mistakes are eliminated once and for all, and all your back-end tasks also taken care of in the most effective manner. It paves the way for a holistic effort that leads to an effective Specialty Pharmacy billing transformation.
Here are some key areas where we can help you.
- Managing patient records: We know how to create proper records that aid in ensuring a smooth reimbursement experience for Specialty Pharmacies. We create them for both providers and payors, with prior information of patient discharges or changes of physicians – all of which are essential to make an accurate medical claim.
- Creating patient demographic entries: We meticulously collect and enter all necessary patient details such as name, age, medication history, diagnostic reports, pathological reports, previous prescriptions and any other data that will be required at the time of submitting the claim.
- Document management/Prior Authorization: We are equipped to work across multiple EHR/EMR systems and ensure that authorization updates are completed in time and diligently updated. As we start updating the billing system early during our engagement with you, it leads to minimal claim denials in the long run. We are equipped to handle any category of drugs as well as any levels of emergency.
- Refill management: We have a highly structured and streamlined refill management process for returning customers. As a responsible Pharmacy billing company, dedicated to patient-satisfaction as much as you are, we make sure in advance that all necessary approvals and reminders are set up so that if anyone comes for a refill, the process is taken care of without any delays.
- AR follow-ups: We go to the root of every account with outstanding dues, irrespective of its size or source. Our team of Accounts Receivable specialists is equipped with a deep understanding of how to work on your aging and current accounts with amazing success. We are experts at collecting from delinquent accounts and have recovered millions for our clients over the years! Moreover, any write-offs, only when they fall absolutely necessary, are done only after your full consent, or we continue to pursue them.
- Payment posting: The most important activity in Specialty Pharmacy billing is finding the best and the most effective approach for reconciliations. We streamline the entire manual payment posting work by automatically posting all received payments, updating the system regularly, and reducing the time spent in data entry.
The Sunknowledge Advantage
- Reduction of your operational cost by 80%
- Closely audited operations with 99.9% overall accuracy
- Proven expertise in handling major specialty pharmacies
- Dedicated resources working in real-time across all time-zones
- Excellent client references from diverse healthcare clients
- No binding contracts or restrictive clauses
- Payer side experience in claim adjudication of 17 yrs
Our team will be glad to share our references, and discuss the best action plan with you that helps you meet your Specialty Pharmacy billing challenges with confidence.
A Truly One-Stop Destination for Specialty Pharmacy Billing Services
We provide a full range of pre- and post-billing solutions, including:
- Insurance Verification & Demographic Entry
- Prior Authorization (incl. Re-authorization and Dr.’s Office Follow-ups)
- Charge Entry, Documentation, EMR update
- Coding and Claim Submissions
- Denial Management & Accounts Receivable Collections
- Virtual Office Assistance (incl. front-desk, prescription refills, reminders & appointments)
At Sunknowledge, we have successfully cracked the Revenue Cycle Management code, ensuring success for all our clients. If you are looking for a knowledgeable, skilled and dependable RCM partner, look no further.
Speak to our team today for a complete change in your practice management story.