MBS for Physicians
Pharmacy
Billing Services
Optimize Your Practice Revenue & Billing Efficiency
Getting Started
We specialize in comprehensive pharmacy revenue cycle management, bringing deep expertise in navigating the complexities of pharmaceutical billing and reimbursement processes.
Our refined solutions are tailored to optimize revenue streams for independent pharmacies, hospital pharmacies, and specialty medication providers. In today’s evolving healthcare landscape, with expanding specialty medication services and complex prior authorization requirements, our billing solutions ensure accurate claims processing while maximizing reimbursement rates.
Our expertise allows pharmacy professionals to focus on patient care while we manage the intricate aspects of revenue optimization.
Medical Billing At A Glance
Explore the key performance metrics that reflect our dedication to accurate coding, reduced denials, and maximized reimbursements for healthcare providers.
Claims Processing Metrics
First Pass Resolution Rate
Percentage of claims paid successfully on first submission.
Average Days to Payment
Average number of days it takes for claims to be paid, typically within 21 days.
Financial Metrics
Net Collection Rate
Percentage of total charges collected successfully.
Denial Resolution Velocity
Average number of days taken to fix and resolve a denied claim, typically within 30 days.
Operational Metrics
Average Monthly Claims
Volume of claims submitted.
Staff Productivity Rate
Claims processed per biller per day.
Pharmacy Billing Services
Driving Claim Accuracy and Compliance for Enhanced Revenue Outcomes
Pharmacy billing presents unique complexities in today’s healthcare landscape, from intricate insurance coverage rules to multi-level data handling requirements. Our comprehensive solutions address these challenges while ensuring compliance with HIPAA regulations and optimizing reimbursement processes across all pharmacy service types, from clinical operations to specialized care delivery models.
- Specialized management of injectable and adjuvant therapy billing
- Expert navigation of bundled payment requirements
- Strategic denial prevention and compliance monitoring
- Comprehensive documentation and audit management
Our billing expertise spans the complete spectrum of pharmacy billing services, ensuring accurate reimbursement while maintaining operational efficiency. We provide tailored solutions for clinical pharmacies, home care services, managed care facilities, and radiopharmacy operations, each with their unique billing requirements and compliance needs.
- Comprehensive clinical and managed care billing services
- Specialized home care pharmacy reimbursement management
- Expert radiopharmacy billing and documentation
- Strategic bundled payment optimization
We excel in navigating complex insurance requirements, particularly focusing on Medicare Prescription Drug Improvement and Modernization (MPDIM) guidelines. Our team ensures optimal reimbursement while maintaining strict regulatory compliance across all pharmacy service types.
- Advanced MPDIM compliance monitoring
- Strategic insurance verification processes
- Comprehensive claim documentation
- Efficient appeal management systems
Our comprehensive approach to pharmacy revenue cycle management ensures maximum reimbursement while maintaining compliance. From initial claim preparation through final payment reconciliation, we handle every aspect of the billing process with precision and expertise.
Detailed coverage eligibility analysis
Strategic claim submission processes
Thorough reimbursement follow-up
Advanced financial reporting and analytics
We implement rigorous quality control measures throughout the pharmacy billing process, ensuring accuracy and compliance while maximizing revenue potential. Our team stays updated with the latest pharmacy billing regulations and coding requirements.
- Comprehensive internal audit protocols
- Continuous compliance monitoring
- Regular staff training and updates
- Proactive denial prevention strategies