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The Future of Pharmacy Billing: Exploring Innovative Software Solutions

The current healthcare system has left pharmacy professionals struggling to prove their value. Medicare Part D’s mandated Direct and Indirect Remuneration (DIR) fees have significantly burdened pharmacies’ revenue streams.

Expanding into clinical services can offer a new revenue stream for pharmacy businesses, but having the right tools to bill for these services is essential.

Medication Synchronization

Medications are essential to patient health and wellness, but lack of adherence is costly to the system. It costs the US healthcare system an estimated $300 billion a year.1 To combat this, pharmacies are adopting medication synchronization and appointment-based medicine (ABM) tools to improve patient outcomes and streamline operations.

A primary goal is improving adherence rates, but Med sync offers several other benefits to patients and pharmacists. These include increased revenue, fewer patient calls, and a more efficient daily workflow. Additionally, med sync increases the likelihood that pharmacists can perform medication therapy management services and counseling with their patients, which are often billable services and sources of revenue.

Another critical aspect of a successful med sync program is effective staff engagement. To this end, pharmacies must adequately train pharmacy technicians, cashiers, and delivery drivers on effectively using a med sync program. They must also ensure that all staff members have a dedicated area for their Med Sync tasks and consistently follow the enrollment process.

Finally, pharmacies must understand the financial model and business case for implementing a med sync program. Depending on the pharmacy’s business model, billing software for pharmacy to compare online will be more effective with the operational efficiencies justify implementing a med sync program. However, med sync will help others enter into value-based care arrangements with payers.

Appointment-Based Model

An appointment-based model allows pharmacists to schedule a time to speak with patients about their medications and answer questions. This helps improve medication adherence, helps detect drug-related problems, and ensures patients receive optimal treatment. The model also reduces the risk of adverse events, which can be costly to patients and health systems.

The model can be a good fit for pharmacy chains and independents that wish to move away from the old “fill-and-bill” approach, as well as for medical practices and other healthcare providers. It is also a good option for payers that want to use pharmacy services to improve patient outcomes. But it’s important to note that the model may require new types of contracts, collaborative practice agreements, and new revenue-generating services.

Creating an appointment-based model requires a new way of thinking for community pharmacists. Rather than considering themselves as medicine dispensers, pharmacists need to consider themselves providers of clinical care services. This will require a shift in the profession’s mindset, and it’s also necessary to overcome barriers preventing pharmacies from moving toward this vision.

The most significant barrier to pharmacists’ becoming clinical service providers is how existing payment models encourage them to focus on product-related revenues. These include PBM rebates and DIR fees, spread pricing, 340B, and other avenues that reward pharmacists for dispensing pharmaceuticals.

Contracts

As pharmacies evolve into more clinical healthcare providers, they must consider new ways to get paid for these services. Medical billing software solutions allow pharmacists to bill third-party payers for services that insurers think are medically unnecessary. These software tools also help pharmacies manage financial risk and prevent costly billing errors.

Pharmacies must improve their customer service to survive in the digital health era. This could include refocusing on point-in-care diagnostics or assisting customers in identifying the best digital health tools for their needs. The latter can consist of helping them set up and configure medical devices and apps and interpret their data.

Another area of opportunity is introducing pharmacist-led wellness, telehealth, and care management programs. These may involve establishing arrangements with local pharmacies or integrating pharmacist-led services into worksite clinics using telepharmacy. This can allow pharmacy executives to increase the value of their services and potentially attract more employees to their profession.

If these new models are to take off, pharmacy professionals need a reliable way to be paid for their cognitive services. This is a significant challenge as only a few pharmacists have managed to bill Medicare Part D for pharmacogenomics-specific MTM services. However, the development of MTM-specific current procedural terminology (CPT) codes has opened the door to more pharmacists being reimbursed by medical insurance for their services.

Dashboards

Using pharmacy software can help reduce processing errors and automate time-consuming tasks. It also allows pharmacists to serve patients better and provide quality healthcare services. Pharmacy software systems can integrate with other types of software, such as inventory management tools, electronic medical records (EMR) programs, and accounting software, to help pharmacies streamline their workflow.

The most comprehensive pharmacy software solutions provide the features pharmacists need to improve their workflow and serve customers more effectively. These features include medication synchronization, barcode scanning technology, and automated refill reminders. Some also offer a mobile app allowing patients to request medication pickup or refills and send messages to pharmacists. In addition, some have a HIPAA-compliant Interactive Voice Response system that can help answer customer questions and inquiries promptly.

Other pharmacy software features that can make running a pharmacy easier include a dashboard aggregating data from various sources to give users a comprehensive business overview. This can help them make informed decisions about their business. In addition, some pharmacy software tools can automatically synchronize data across multiple locations to reduce the risk of data loss.

One such pharmacy management software solution was developed directly responding to pharmacist needs. It includes many features that can be tailored to different pharmacies, including long-term, compounding, and specialty pharmacies. Pharmacists can track drug sales and orders using the solution and manage their inventory. They can also customize their patient profiles and send patient reminders by text or email.

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