We Guarantee Improved Medical Billing Efficiency, Effectiveness & Compliance

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of claim denials are overturned
improvement in net patient revenue
of claims are collected within 90 days or less
clean claims rate
average reduction in AR days

Pharmacy Billing Services

Unlock the Service Benefits of a Professional Pharmacy Billing Company

Imagine a world where your pharmacy’s revenue cycle management is seamless, efficient, and accurate. Sounds like a dream, right? That dream can become a reality by unlocking the benefits of professional pharmacy billing services.

In this blog post, we will dive deep into the world of pharmacy billing, exploring key components, streamlining processes, enhancing revenue cycle management, and revealing the Fortis Medical Billing advantage. Get ready to revolutionize your pharmacy’s billing operations and maximize revenue.

Key Takeaways

  • Professional pharmacy billing services can optimize efficiency and revenue for pharmacies.
  • Automated systems, accurate coding practices, and prior authorization management are key components of reliable pharmacy billing solutions.
  • Partnering with experts like Fortis Medical Billing can reduce denials & errors while improving collection rates & optimizing revenue cycle management.

Understanding Pharmacy Billing Services

Pharmacy billing, also referred to as pharmacy medical billing, involves the submission of patient data and insurance details for medication and the subsequent dispensing of drugs. Despite appearing straightforward, the process can be arduous due to issues like the exclusion of certain drugs from insurance coverage and intricate data handling, leading to potential medical claim rejections. One might wonder how to maneuver these hurdles to guarantee efficient and accurate billing for your pharmacy.

Enter professional pharmacy billing services. Fortis Medical Billing offers reliable billing solutions that can improve efficiency and revenue for pharmacies by streamlining the billing process, which includes Pharmacy Benefit Management and claims processing.

A doctor talking with a patient in a pharmacy.

Pharmacy Benefit Management

Pharmacy Benefit Management is all about negotiating drug prices and administering medication plans. It begins with obtaining the mail order from the PBM team, which is responsible for ensuring accurate and timely reimbursement of prescribed medications by healthcare providers, taking into account the patient’s medical history. Effective management of these benefits allows pharmacies to procure better discounts, negotiate costs effectively, and hence, boost their profit margin.

However, relying solely on Pharmacy Benefit Management doesn’t ensure a flawless billing process. Claims processing plays a vital role in ensuring that pharmacies receive accurate reimbursements for their services, as it deals with the verification of patient and physician details, as well as the submission of claims to a relevant insurance company.

Medical Claims Processing

Medical claims processing, a key facet of billing services, guarantees that pharmacies are compensated accurately and promptly for their services. This process involves:

  • Confirming patient information
  • Coding diagnoses and procedures according to standards
  • Submitting claims to relevant insurance companies
  • Monitoring claim status

By guaranteeing precise and prompt remuneration for healthcare services delivered, claims processing reduces the burden of non-clinical paperwork for healthcare providers.

In summary, a comprehensive billing service ought to encompass both Pharmacy Benefit Management and claims processing while considering the implementation of a bundled payment model to yield the optimal results for pharmacies. With these pharmacy services in place, pharmacies can minimize errors and maximize the efficiency of their billing processes.

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Key Components of Reliable Pharmacy Billing Services

Trustworthy billing services emphasize accurate billing and coding, coupled with regulatory compliance, to reduce claim denials and enhance revenue. Let’s explore these key components in more detail and understand how they can make a significant difference in your pharmacy’s billing operations.

A pharmacist and a medical billing expert discussing billing services.

Accurate Billing and Coding

Precise billing and coding play a pivotal role in diminishing claim denials and securing timely compensations for pharmacies. By maintaining accuracy in coding, healthcare providers can avoid errors, compliance issues, audits, penalties, fraud, and abuse. Additionally, accurate coding helps ensure patients are not overcharged for procedures and services.

Transparent billing is another crucial aspect of accurate billing. It guarantees precise record-keeping and safeguards against revenue loss. With a comprehensive Pharmacy Charge Description Master (CDM), pharmacies can mitigate revenue loss and ensure that all billable items and associated quantities are accurately recorded.

Compliance with Regulations

Adherence to regulations is vital to evade penalties and uphold a favorable reputation within the healthcare industry. Abiding by applicable laws, regulations, guidelines, and specifications ensures that your pharmacy operates within the legal framework and avoids potential penalties or legal consequences.

Compliance goes hand in hand with accurate billing and coding, as adhering to regulations is vital for reducing claim rejections and guaranteeing that pharmacies follow all applicable laws and regulations. By partnering with reliable billing services like Fortis Medical Billing, you can ensure that your pharmacy remains compliant and avoids penalties while benefiting from expert guidance and support.

Streamlining the Pharmacy Billing Process

Efficient streamlining of the billing process entails the deployment of automated systems and billing software, along with effective management of prior authorizations, all aimed at boosting efficiency and diminishing errors.

Let’s delve into how these strategies can revolutionize your pharmacy’s billing operations and contribute to a more efficient and profitable business.

A computer with automated billing software.

Automated Systems and Billing Software

Deployment of automated systems and billing software aids pharmacies in managing their billing processes with enhanced efficiency and accuracy, thereby curtailing the probability of errors and claim denials. By automating processes and leveraging tools like Chargebee, Zoho Books, and BillingPlatform, pharmacies can streamline eligibility verification and resubmission of unpaid claims, as well as decrease errors and delays in payments.

Automation also facilitates claims processing with accurate patient and payment records, allowing pharmacies to prioritize core functions and focus on providing exceptional patient care. By investing in the right automated systems and billing software, pharmacies can save time, reduce errors, and significantly enhance their billing operations.

Prior Authorization Management

Effective management of prior authorizations includes:

  • Verifying the medical necessity of requested medications and services
  • Confirming the patient’s eligibility for the requested services
  • Ensuring that pharmacies do not submit claims for services not covered by the patient’s insurance plan

By implementing these practices, prior authorization management helps to decrease the risk of claim denials and delays in reimbursement.

The advantages of prior authorization management include decreased claim denials, enhanced reimbursement rates, and enhanced patient care. By guaranteeing that pharmacies are submitting claims for services that are medically essential and covered by the patient’s insurance plan, prior authorization management helps to optimize revenue and improve the overall financial health of pharmacies.

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Enhancing Revenue Cycle Management with Expert Pharmacy Billing Solutions

Expert billing enhances revenue cycle management by reducing payer denials and errors and improving collection rates for pharmacies. Let’s examine how these solutions can bolster your pharmacy’s financial performance and help you achieve greater success.

A pharmacist looking at the revenue cycle management on a computer.

Reducing Payer Denials and Errors

Minimization of payer denials and errors is indispensable for optimizing cash flow and guaranteeing prompt reimbursements for pharmacies. By partnering with a professional billing company like Fortis Medical Billing, you gain access to a team of experts who can help minimize denials and errors through accurate billing and coding, adherence to regulations, and the use of automated systems and billing software.

The advantages of reducing payer denials and errors include improved collection rates, a knowledgeable team, and tailored solutions. With these benefits, pharmacies can optimize their revenue cycle management and focus on providing exceptional patient care.

Improving Collection Rates

Boosting collection rates enables pharmacies to augment their revenue and sustain a robust financial standing. By utilizing professional pharmacy billing services, pharmacies can minimize denials and errors, optimize the billing process, and adhere to regulatory requirements, all of which contribute to improved collection rates.

Furthermore, the essential elements of dependable pharmacy billing services, such as precise billing and coding, adherence to regulations, and prior authorization management, work together to ensure a more efficient and profitable billing process. As a result, pharmacies can enjoy increased revenues and a stronger financial foundation.

A pharmacist using pharmacy billing services to improve collection rates.

The Fortis Medical Billing Advantage

Fortis Medical Billing encompasses a seasoned team of ex-FBI agents, medical billing specialists, and certified coders, along with bespoke solutions designed to cater to the unique needs of each pharmacy.

Let’s explore how the Fortis Medical Billing advantage can transform your pharmacy’s billing operations and drive your business towards greater success.

A team of experienced professionals working on pharmacy billing solutions.

Experienced Team

The well-versed team at Fortis Medical Billing guarantees accurate and compliant pharmacy billing services, thereby enhancing efficiency and revenue for pharmacies. The team’s expertise spans the most up-to-date pharmacy billing regulations and procedures, guaranteeing precise and compliant billing services.

With a wealth of expertise in pharmacy billing, the Fortis Medical Billing team can increase productivity and revenue for pharmacies. By partnering with Fortis Medical Billing, your pharmacy can rest assured that your billing operations are in the hands of highly trained, skilled, and experienced professionals who are passionate about accurate and compliant medical billing.

Customized Solutions

Bespoke solutions from Fortis Medical Billing are designed to meet the distinct needs of each pharmacy, assuring optimal outcomes and a high client retention rate. We provide a comprehensive suite of services that can be customized to meet the unique needs of each pharmacy, including:

  • Billing and coding services
  • Compliance with regulations
  • Automated systems and billing software
  • Prior authorization management
  • And more.

The advantages of Fortis Medical Billing’s customized solutions include reduced payer denials and errors, enhanced collection rates, and optimized revenue cycle management. By offering tailored solutions that address each pharmacy’s specific challenges and goals, we help pharmacies achieve unparalleled success in their billing operations and overall financial performance.

Case Studies: Success Stories in Pharmacy Billing Services

Case studies serve as a testament to the success of Fortis Medical Billing’s pharmacy billing services, highlighting enhanced revenue cycles and operations for healthcare providers. These success stories offer insight into how expert pharmacy billing solutions can optimize revenue cycles and operations for healthcare providers.

Notable examples of successful case studies include AssureCare, RXinsider, Gentem, and MedBillingExperts. These case studies highlight the benefits of outsourcing pharmacy billing services for home-bound patients, such as improved cash flow, eliminating billing headaches, collecting more money faster, reduced staffing liabilities, and reduced payer denials and errors.

By learning from these success stories, pharmacies can gain valuable insights into the potential benefits of partnering with professional pharmacy billing services like ours. These case studies serve as a testament to the transformative power of expert pharmacy billing solutions and their ability to revolutionize revenue cycles and operations for healthcare providers.

A pharmacist satisfied with pharmacy billing services.


In conclusion, professional pharmacy billing services can revolutionize your pharmacy’s billing operations, leading to improved efficiency, accuracy, and revenue. By focusing on key components such as accurate billing and coding, compliance with regulations, streamlined processes, and expert solutions, Fortis Medical Billing can help your pharmacy unlock the true potential of its billing operations. With our advantage, your pharmacy can enjoy the benefits of an experienced team and customized solutions tailored to your unique needs. Don’t wait any longer – transform your pharmacy’s billing operations today and set your business on the path to success.

Frequently Asked Questions

What is a pharmacy billing system?

A pharmacy billing system is software used by pharmacies to bill services to the medical benefit and handle government and commercial insurance payers. It also allows patients to receive prescription medications, pay co-pays, and have them administered in the provider’s office.

What CPT codes can a pharmacist bill?

Pharmacists can bill for services under “incident-to” codes, ranging from 99211 to 99215, with most typically being reimbursed under the 99211 code. However, regional payer requirements may require pharmacists to utilize their NPI number.

How much are pharmacists paid for MTM services?

Pharmacists are typically paid $1.44 per minute, or $86.4 per hour, for MTM services.

What challenges can pharmacies face while managing their billing processes internally?

Pharmacies face the challenge of dealing with excluded drugs from insurance coverage, handling multiple levels of data, and dealing with medical claim rejections.

How does Pharmacy Benefit Management relate to medical claims processing?

Pharmacy Benefit Management negotiates drug prices and administers medication plans, while claims processing handles timely reimbursement of prescribed medications. Together, they enable efficient management of the medication process.