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Greedy PBM reimbursement rates are crushing pharmacies everywhere.
They don’t want you to know you could increase reimbursement rates by thousands of dollars a year by billing to medical insurance.
That’s why we’re telling everyone. We call it…
Across the country, extremely low reimbursement rates set by PBMs have been crushing pharmacy businesses and the patients that depend on them.
It’s not an accident. The truth is that fine-print details about how and where pharmacists perform services can change your reimbursement rates by hundreds or thousands of dollars.
See for yourself. Use our Payback Calculator to see how much additional revenue you could add to your pharmacy business every year with medical billing and medical claims submission.
About the Payback Calculator: this calculator creates an estimate based on flu vaccine reimbursements (self-reported and publicly available data). This estimate is intended to educate about the significant disparity between Pharmacy d.0 (PBM) and medical insurance reimbursement rates. It may not be accurate or representative. Actual medical insurance reimbursement rates vary by vaccine product, payer and state.
About the Payback Calculator: this calculator creates an estimate based on flu vaccine reimbursements (self-reported and publicly available data). This estimate is intended to educate about the significant disparity between Pharmacy d.0 (PBM) and medical insurance reimbursement rates. It may not be accurate or representative. Actual medical insurance reimbursement rates vary by vaccine product, payer and state.
You read that right.
In most cases, medical professionals with “provider status” (doctors, physicians, etc) get reimbursed through medical insurance for BOTH the vaccines they administer AND the act of putting the needle in a patient’s arm.
In most cases, pharmacies submitting vaccine reimbursements to d.0 are getting reimbursed for ONLY the vaccine itself, and not the administration.
This is one huge reason why medical reimbursements and pharmacy d.0 reimbursements can vary so wildly for the same vaccine.
Pharmacists deserve to know the facts about both medical billing AND pharmacy billing.
They deserve to make informed decisions about where to submit reimbursements to maximize return for their businesses, and get support doing so if they need it.
PBM reimbursements aren’t always a bad idea — but you deserve to choose.
There are absolutely situations when choosing d.0 over medical insurance can benefit a pharmacy.
For example, some PBMs remit reimbursements faster than most medical insurance plans for treatments like vaccines. You may decide you’re willing to accept a lower reimbursement rate for a faster timeline.
But you can’t make that choice if you can’t submit to medical insurance plans in the first place.
Changing that status quo and giving pharmacists more power over their reimbursements is what #PharmacyPaybackTime is all about.
Scripted is as a game-changer in the pharmacy billing landscape, offering a comprehensive solution to streamline the process and enhance revenue capture.
Scripted’s user-friendly interface simplifies claim submission, reduces coding errors, and automates claim follow-up, freeing pharmacists to focus on patient care.
Everything pharmacists need to know about medical claims, codes, and revenue cycle management.
Guidance for pharmacies on using appropriate CPT & ICD-10 codes to ensure accurate medical claims submissions.
What should I know about billing for pharmacy services?
Pharmacists billing for services like test-to-treat and vaccinations will need to learn about the process of billing both cash-pay and medical insurance so they can best serve their patients. It can be a bit complicated, but don’t worry — we’re here to help.
First, you’ll want to make sure you’re adhering to all regulations and policy guidelines in your state. For example, you’ll likely need a CLIA waiver before you can offer test-to-treat.
You’ll also need to know which reimbursement and payment options will bring the most revenue to your business: cash-pay (i.e. without insurance), pharmacy benefit, and medical benefit are some options.
What are the benefits of medical billing for pharmacists?
There are many benefits to medical billing for pharmacists.
With medical billing, you can bill patients’ medical insurance plans for advanced services at your pharmacy in addition to cash-pay.
You’ll add a new high-margin revenue stream to your business, while also providing even better care to patients in your community. Pharmacists with medical billing may also improve revenue cycle management at their pharmacies.
What makes medical billing difficult for pharmacists who don’t have Scripted?
Medical billing can be a complex and time-consuming process, but it’s essential for getting reimbursed for advanced services you provide to your patients.
Common barriers pharmacists face when trying to bring medical coding and billing to their businesses include:
Scripted automates medical coding for advanced pharmacies services and files insurance claims on your behalf so you get reimbursed properly.
Plus, get support from a real-live human within hours if you have a question or something goes wrong.
Does Scripted offer pharmacist credentialing and provider enrollment, too?
Yes — this is traditionally the most time- and energy-consuming part of this process due to the amount of information required from each pharmacist on your team.
We’ve partially automated this process, and also have relationships with preferred networks to accelerate credentialing.
Pharmacy benefit vs. medical benefit: is there a difference?
YES! Understanding the difference between pharmacy benefit reimbursement and medical benefit reimbursement is crucial for bringing the most revenue to your pharmacy for the services you offer.
Many pharmacies aren’t yet aware that medical contracting for their pharmacy staff can dramatically improve margins on even basic vaccine services.
Here’s how: when a physician gives a vaccine and submits it to insurance for medical benefit reimbursement, they get reimbursed for BOTH the medication and their labor.
In most cases, pharmacy benefit reimbursements will ONLY cover the medication — in other words, you’d be administering the vaccine for free.
Here’s the good news: we can help you bill medical benefits retroactively for up to 180 days post-vaccine administration. Fill out the form at the top of the page to learn more.
Can pharmacists legally bill insurance from services? What other regulations in my state are important to know?
We offer free consultancy regarding regulatory compliance in all 50 states.
Drop us a line and we’ll discuss with your team.
Need support? Have a question? We’re here to help.
