Pharmacy Billing Services

Optimized Pharmacy Billing: Expert Management for Maximum Returns

Welcome to Philadelphia Medical Billing Services. Our primary focus is to assist pharmacists and pharmacy companies in optimizing their billing systems and profits. We effectively oversee all the billing responsibilities inbound from accurate claims submission and denial management while adhering to the industry rules and regulations. By using state-of-the-art solutions and our extensive knowledge of the healthcare industry, we reduce the likelihood of mistakes and shorten the time for gaining reimbursement. Thus, allowing you to concentrate on delivering superb quality patient care.

What Philadelphia Medical Billing Services Can Do for Your?

At Philadelphia Medical Billing Services, we go beyond basic billing solutions. We offer a comprehensive range of pharmacy billing services designed to address every aspect of your billing process, ensuring accuracy, compliance, and efficiency at every step.

Medication Claim Processing

We verify benefits, code prescriptions, and file claims quickly to reduce denials and improve reimbursement.

Controlled Substance Billing

We handle permits and ensure compliance with federal and state laws for controlled medication billing.

Compounding Pharmacy Billing

We create tailored billing for compounded medications, handling coding and payer rules.

Medicare and Medicaid billing

We manage Medicare and Medicaid claims, ensuring compliance and timely reimbursement for services.

Prior Authorization for Specialty Medicines

We oversee the entire prior authorization process for high-cost specialty medications, avoiding delays.

Billing for Immunization Services

We ensure accurate billing for vaccines, streamlining claims for immunization services provided by pharmacies.

Why Choose Philadelphia Medical Billing Services for your Pharmacy billing?

Our pharmacy billing staff comprises personnel, with over 95% of them having specialization in pharmacy billing laws to ensure that every claim is legal and correct.
Our billing services are perfect for all types of pharmacies, including retail chains, compounders, and specialty pharmacies, securing every billing aspect 100% for you.
Clients report an average revenue increase of 20-30% within the first year due to our efficient management of pharmacy claims and our focus on maximizing reimbursements for medications.
With our pharmacy billing software, we can track claims in real-time, resolving 90 percent of problems before they result in denials and facilitating timely reimbursement for dispensed drugs.

Pharmacy Billing Process We Follow

At Philadelphia Medical Billing Services, we understand that pharmacy billing is a complex and detail-oriented process that requires precision at every step. Below is an overview of the key steps we follow in our pharmacy billing process:

Initial Patient Information Gathering

First of all, we gather basic demographic patient data, experience with insurance, a list of prescribed drugs, and other relevant documents. This step helps to ensure that the data is correct for enabling effective billing or claim processing.

Verification of Insurance Benefits

Our team confirms the patient’s insurance and the extent to which such insurance will cover the prescribed medication, co-pay, or deductible. Such verification assists in avoiding patient's claim rejection and lets patients understand the costs they will have to cover.

Claim Preparation and Submission

We format the claims based on the verified patient and prescription details for filing with insurance payers. For each medication, we employ accurate coding strictly aligned with payer specifications to minimize denied claims.

Payment Posting

Once we receive payments from insurers, we ensure that these have been correctly entered in the patient’s account. This step involves making any necessary additions, co-payments, or balances that may not have been covered by the insurance.

Denial Management and Appeals

When our claim is turned down, we immediately seek to find out why it was rejected and take the necessary actions. Our team communicates with payers, requests necessary appeals, and submits supportive documentation where required to ensure that we receive reimbursement.

Patient Billing and Follow-Up

We then prepare easily understandable and professional bills for patients, which are presented as accounts that include the balance and service received. We also have separate reminders for patients for the payment and to ask them whether they have any questions or not.

Optimize Your Pharmacy Billing Today

Are you looking for an opportunity to simplify the process of pharmacy billing and increase the overall revenue? Get in touch with us today to find out how our tailored services can improve your billing and enhance your profitability.