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:

• Contracting with commercial payers
• The huge administrative burden and time commitment with few support options
• Identifying appropriate billing codes for pharmacists
• Lack of provider status and acknowledgement from payers
• Complex coding details like CPT codes and ICD-10 codes
• Trying to handle all of that on top of running a pharmacy business

Scripted’s pharmacy medical billing software 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.