Specialty pharmacy is a branch of pharmacy that provides medications for chronic, and rare health conditions. These conditions include cancer, rheumatoid arthritis, and multiple sclerosis. However, these medications often require special handling, administration, or monitoring due to their high cost and complex dosing regimens. According to KFF, between FY 2017 and FY 2023, net Medicaid spending on prescription drugs increased by 72% which shows the growing specialty pharmacy market. But as the healthcare regulations are constantly changing, that’s why it is becoming difficult for the providers to comply with the updated regulations as they have other important tasks to do.
So, what to do in that case?
That’s where a specialty pharmacy billing company steps in. Their dedicated experts know all the complex nuances of the CPT and ICD codes to reduce coding inaccuracies. Moreover, they also thoroughly comply with the HIPAA law to make sure the data is totally safe and secure. But how do they create an accurate billing process that gives the providers quicker reimbursement? Let's jump to the answer to this question.
Top 3 Advantages of Choosing a Specialty Pharmacy Billing Company
Complying with the updated regulations: As healthcare regulations are continuously changing, that’s why it becomes difficult for healthcare resources to comply with the updated regulations. That’s where the third-party billing company comes into the picture. Their dedicated experts stay updated with the latest healthcare laws, which include HIPAA law, to make sure that the patient data is safe and secure. Apart from that, there are several CPT and ICD codes used in specialty pharmacies such as:
CPT codes:
• 96372 for therapeutic, prophylactic, and diagnostic injection.
• 96413 for Chemotherapy administration, intravenous infusion
• J-codes for injectable drugs.
ICD codes:
• C50.911 is for Breast cancer.
• M06.9 is for Rheumatoid arthritis.
• E10.9 is for Type 1 diabetes.
• L40.0 is for Psoriasis vulgaris.
• G35 is for Multiple sclerosis.
So, getting updated about all these specific codes is very difficult for the healthcare staff. That's where the third-party billing experts can help you integrate all the proper codes for the specific treatments to make a streamlined claim submission.
Helping with prior authorization process: Prior authorization is a complex process because of the varying requirements of the insurers. That’s where the specialty pharmacy billing company steps in. Their dedicated experts collect all the necessary patient information, verify the insurance requirements, and then submit the PA request on behalf of the healthcare provider. Moreover, these experts track the status of the submitted claim and then follow up to ensure timely reimbursements. Hence, with their help, the healthcare staff can invest their time in patient care.
Reduced operational cost: The in-house billing team comes with a high cost. It is because you have to train them and also buy separate office space for them. On the contrary, the outsourced billing companies don’t need any additional training as they keep on training themselves. Apart from that, these experts also don’t require any office space as the outsourced billing company provides them with the required office space. A report from ScienceDirect stated that the providers have noticed an increased ROI ranging from $1.29 to $18.50 per dollar spent on pharmacist billing service. Hence, with the help of these outsourced billing experts, you can save massive healthcare operational costs which you can invest in other healthcare operations.
Final Thoughts
In short, it can be stated that the healthcare staff performs almost all the healthcare operations. Now, as the billing regulations are changing, these staff don’t get enough time to update themselves with these regulations, which leads to billing errors. That’s where the specialty pharmacy billing company comes in with its dedicated experts. These experts stay updated with the updated billing regulations and also help with the complex prior authorization process. Hence, with their help, your staff can invest their time in improving patient care, which will eventually lead to increased healthcare revenue.