When Should You Hire a Specialty Pharmacy Billing Company?

Handling expensive, complicated medicines for conditions like cancer, hepatitis C, and orphan diseases generally falls under the purview of the chief roles of a specialty pharmacy, besides, of course, supplying them and sometimes, manufacturing them too. These medicines not only require special handling, storage, and administration, but patients also need to be educated about them for the best results. Moreover, because of the very high growth rate of the market, specialty medication is estimated to reach USD 965.54 billion by 2030 with a CAGR of 39.80%. However, this domain regularly struggles with many pre and post-specialty pharmacy billing challenges.

Understanding the Challenges of Specialty Pharmacy Billing

Specialty pharmacy billing is replete with challenges:

• Specialty Medication Coding and Billing Guidelines: Specialty medicines have special coding requirements (e.g., HCPCS, CPT), and improper coding leads to denials or underpayment, impacting revenue adversely
• Processing Multiple Insurance Policies: Practices must process medical and pharmacy benefit policies with differing rules for reimbursement and coverage, and it is complex
• Prior Authorizations and Step Therapy Protocols: Prior authorizations or step therapy, in which patients are initially prescribed cheaper alternatives, impose additional administrative burden
• Regulatory Changes: Constant changes in regulations and payer policy require constant vigilance to avoid penalties and ensure compliance
• High Cost of Medications: High cost of specialty medication makes billing mistakes lead to large dollar losses, and hence maintaining high standards of accuracy is imperative

Keeping professional billing optimized with an in-house set of billers is a costly affair, especially for small practice settings. With these challenges taken into consideration, outsourcing is the strategic choice for this function.

Sunknowledge Offers Tailored Solutions in Specialty Pharmacy Billing

At Sunknowledge Inc., we have been assisting specialty pharmacy centers across the US for years with meticulously tailored billing solutions. Outsourcing your billing tasks to us can be a superior alternative to in-house billing for a host of reasons, benefiting you in many ways like lowering cost and bridging the expertise gap.

• Cost Savings: In-house billing is expensive to operate, particularly in small pharmacies, whereas offshore outsourcing to us helps you save big as we only charge $7 an hour.
• Specialization: We have medical billing experts with deep coding, regulation, and payer policy expertise. This type of specialization minimizes errors, optimizes reimbursement rates, and speeds up cash flow.
• Scaling: With greater practice size, outsourcing your services to us can help scale up activity to accommodate more claims without having to increase new employees.
• Time and Concentration: Our support enables people to focus on the care of the patients, bringing about an improvement in the quality of operations and services.
• Productivity and Technology: We are known to employ cutting-edge systems to automate processes, reduce reimbursement time, post claims filing and more, and all these are important as there are expensive drugs in question.
• Compliance and Risk Management: We are expert in understanding reimbursement regulations, reducing the risk of mistakes and fines, and enabling practices to remain compliant.

Sunknowledge Springs Ahead

In nearly the last two decades, Sunknowledge has emerged as one of the leading outsourced billing companies of revenue cycle management (RCM) solutions to healthcare providers like hospitals, clinics, select healthcare practices and of course, specialty pharmacies. We provide comprehensive medical billing services, coding, and virtual care services to 30+ specialties in 50 US states, including New York, Florida, California, New Jersey and more. We stand apart with our:

• Specialty-wide knowledge: We possess overall knowledge, ensuring comprehensive expertise in specialty pharmacy billing with 99.9% accurate coding
• Proprietary technologies: We implement superior, proprietary workflows and technologies for effective, accurate billing with fewer errors and maximum reimbursement
• Collection focus: Our unwavering collection focus eliminates billing headaches, improving cash-flow, and has customers reporting record prior authorization assistance

Global presence: We are serving clients spread all over the 50 States

Tailored solutions, regular reporting, and ongoing training enable practices to keep performance up to date and stay alert. Becoming a strategic business partner with Sunknowledge for specialty pharmacies makes you assured of optimizing business in an effective and compliant manner. Not only does this provide financial security to practices but ensures improved patient-care too, because we help practices focus on the clinical work at hand while leaving the administrative chores to us.