Expanding into clinical care is one of the best actions a pharmacy can take. It provides a new revenue stream for your store, plus more health care options for your community.
Pharmacy Billing Vs. Medical Billing
- Medical Claims Uses Different Format than Pharmacy Billing
- Medical Claims are in a Different Format than Pharmacy Claims
- Pharmacy Claims Billing Uses Only Prescription Number and NDC Codes
- Medical Billing Uses HCPCS and CPT Codes
- Medical Claims Take Longer to Reimburse
- Pharmacy Claims Submitted Through PBM Deny or Approve Almost Instantly and Often Reimburse Lower Rates.
- Medical Claims Take 30-60 Days for Adjudication and Payment and May Require Resubmission
- Pharmacy Claims are Easier to Submit
- Pharmacy Claim Submission Through PBM is Very Simple and is Almost Always Approved if Requirements Are Met (Physician Prescribed and Drug is on Formulary of the Insurance Plan)
- Medical Claim Submission Has Several Policies That Often Cause Complications in the Process, Including Providing Documentation of the Services Provided.
Additional Areas of Revenue
Area # 1
Medication Therapy Management (MTM)
Medication Therapy Management (MTM)
Area # 2
-
Injections:
- Flu
- Immunizations
- Other Injections
Area # 3
RT PCR Programs with Partner Laboratory
RT PCR Programs with Partner Laboratory
Area # 4
-
CLIA Waived Testing
- Covid Antigen
- Covid “Rapid PCR”
- Influenza A&B
- Strep
Area # 5
Diabetic Supplies – Part B
Diabetic Supplies – Part B
Area # 6
Infusion Therapies
Infusion Therapies
Area # 7
Pop-up Mini Clinic