Specialty Pharmacy

Medical Billing for Specialty Pharmacy
- Seamless & Perfect Billing Support

Medical Billing for Specialty Pharmacy - Seamless & Perfect Billing Support

Specialty Pharmacy Billing

Specialty pharmacies serve patients with complex and chronic medical conditions through supply of specialty medications to treat rare or complex health conditions. As specialty pharmacy manages rare, chronic, and often complex medical conditions, it requires an increased level of patient management, specific dosing guidance, and counselling.
Because of complexities of services and high cost of specialty medicines, it is imperative to manage reimbursement process efficiently. The complexities of the medical billing world make billing for clinical care difficult for many pharmacies. RCM Workshop’s billing services for specialty pharmacies assist you manage the complexities and challenges in billing efficiently, and get the appropriate reimbursement for your services. With a thorough and in-depth knowledge of operations workflow for specialty pharmacy coupled with our standardized medical billing process, our pharmacy billing experts add exceptional value at every stages starting from coverage determination, prior authorization to billing submission and collection.

Unbeatable Service, Quality & Price

ACCURACY
0 %
TURNAROUND TIME
< 0 Hours
COLLECTION
0 %
PRICE
Starting from $ 1100 /Month

OUR PROCESS

Our Specialty Pharmacy Billing Process Workflow

Our medical billing workflow has been tailored considering the critical success factors of specialty pharmacy billing process. With adequate experience and knowledge, our expert billers perform billing activities accurately and diligently to ensure timely and appropriate reimbursement. With a faster turn around time and an efficient standard operating procedure, our authorization specialists work with payers and providers to obtain prior authorization.
Our billing experts work diligently and follows industry standard best practices for revenue cycle management to minimize errors and reduce claim rejection rates, resulting in better turnaround time and higher revenues for your practice. Our efficient process for denial management and AR follow-up ensures timely payment and eliminates payment delay. Our KPI metrics driven reporting tool captures and reports every aspect of process performance – productivity, quality and $ collections in a transparent way and gives you full control over your billing process.

Order Intake

Streamlined process for receipt, routing, and handling of prescription referrals; coordination with multiple stakeholders and order entry.

Eligibility & Benefits Verification

Confirm patient primary and secondary insurance and benefits coverage and verify the patients’ coverage, co-pays, co-insurance and deductibles

Prior Authorization

Initiate request for prior authorization with the payer, follow-up to check Auth status till closure and finally update the system with Auth approval reference number.

Code Review & Audit

Check accuracy of codes and modifier according to specialty and assign corresponding and appropriate charges to the codes.

Charge Posting

Audit the claims thoroughly to check for accuracy and edit if necessary and submit claims – both EDI and paper format.

Claims Edit & Submission

Audit the claims thoroughly to check for accuracy and edit if necessary and submit claims – both EDI and paper format.

Payment Posting

Carry out both auto as well as manual posting for payments received and conduct reconciliation against claims.

Denial Management

Analyse and categorize denial claims according to denial codes, $ amount and payers, and resubmit claims after correction.

AR Management

Follow-up with payers to gather status for unpaid claims, and their resolution.

Patient Collection

Sending patient statements and follow-up with patients for final and outstanding payment.
Tailored to your specific needs, you can confidently rely on us to manage your entire billing process, or you have the flexibility to select specific billing services that suit your needs, ensuring a seamless operation without any interruptions.

BEST PRACTICES

Our Specialty Pharmacy Billing Best Practices

Leveraging data analytics and experience in pharmacy billing, we have established a foundation of best practices to support medical billing for specialty medicines. Our services are focused to meet specific needs of specialty pharmacy practices and ensure a seamless support for your billing requirements and operations. Our proficiency in healthcare revenue cycle management significantly contributes to streamlining your medical billing processes and ensures full compliance with billing regulations.

BENEFITS

Outcomes guaranteed

The comprehensive revenue cycle process backed by data analytics and metrics based operation management helps in optimizing revenue cycle process to ensure a superior quality outcome consistently. We assure you a much-improved financial outcome – maximized revenue, steady cash flow and reduced operational cost.

Efficient insurance verification

>99% clean claim submission

Efficient authorization management

<24 hours turn-around time

Efficient coding & code review

>25% increased reimbursement

Efficient denial management

<5% claims denials

Proactive accounts receivable follow-up

<40 days AR & reduced aging

Better coordination & documentation

improved revenue cycle

WHY US?

Why partner with us

Our revenue cycle service encompasses all facets of your specialty pharmacy billing needs, seamlessly integrating into your existing billing infrastructure. By following medical billing best practices and protocol for quality assurance and compliance, our dedicated team provides a superior and improved billing service. We are committed to delivering unparalleled support and productivity, while helping you optimize your revenue cycle. Partner with us today for exceptional outcomes and transform your billing process.

Guaranteed Improvement in Reimbursement and
Cash Flow

Assured Reduction
in Denials and AR

Transparent reporting
–NO BLACK BOX

100% data security
& HIPAA compliance

On demand scale up
of operation

Significant Reduction
in Cost > 75% Savings

Simple & No
Cost transition

Flexible & Unbeatable
Pricing Plan