Navigating Medical Billing Part 2​: Examining Medical Billing Opportunities Pharmacies Should Leverage

Pharmacies and their accessibility play an increasingly important role in the US healthcare system. The Pharmacy landscape is evolving beyond simply filling prescriptions; it’s transforming into the front door of healthcare. Consumers across the country demand more convenient access to care, healthcare deserts that lack vital primary care resources litter communities nationwide, and advocates for improving community health continuously push for better health outcomes.  

The reasons pharmacy teams are needed to shore up healthcare in the US are clear. Offering clinical care services in pharmacies can help fill in healthcare gaps nationwide. Venturing into clinical care gives pharmacies the leeway to drive revenue by tapping into medical billing and reimbursement. Here are the top three opportunities pharmacy teams should consider when exploring medical billing possibilities.  

Legislative Changes Support the Expansion of Pharmacy Care

The movement to expand pharmacists’ roles has been underway for several years, and legislation supporting expanding the role of pharmacists as providers has been introduced in dozens of states.  

The pandemic put pharmacists in the spotlight, highlighting their accessibility as healthcare providers and their willingness and ability to serve patients in a more valuable way. Recent legislative and regulatory changes have begun to remove the barriers to pharmacists, providing more clinical services to patients. 

As pharmacists play an increasingly important role in delivering healthcare services and helping patients better manage long-term chronic conditions, consumers get more convenient access to clinical care closer to home.  

In addition to better serving patients, more clinical services delivered at the pharmacy also play an important financial role for pharmacies. As profit margins from prescription dispensing continue to fall, pharmacies need to add new revenue streams. Expanding the menu of clinical services offered at the pharmacy creates an opportunity to drive new revenue. 

A Looming Physician Shortage Creates a Care Gap that Pharmacists Can Help Fill

An Association of American Medical Colleges report estimates a shortage of more than 100,000 physicians in America by 2032.1 This includes up to 55,000 primary care physicians and up to 65,000 specialty care providers. There is also an ongoing nurse shortage that is expected to persist and grow.2 All of these factors make the pharmacist’s role as a provider of clinical services more critical and valuable.  

Clearly, for pharmacists to help fill this gap by providing clinical services, there must be processes and technology in place that make it easier to both deliver clinical services and be reimbursed for them. Many pharmacists are already challenged by a shortage of pharmacy techs and other staff.   

While the looming physician shortage coupled with the accessibility of pharmacies to the vast majority of Americans creates a tremendous opportunity for pharmacies and pharmacists to deliver more clinical services, they need resources and technology solutions to optimize delivery and billing. 

The Ability to Alleviate Administrative Stress

Across the country, pharmacists are dealing with escalating job demands and staffing challenges. This creates stress. Pharmacists need solutions that help them operate at the top of their licenses without adding administrative burdens or workflow workarounds. 

To maximize reimbursement from clinical services, pharmacies need to augment their pharmacy billing systems with supplemental medical billing capabilities that integrate seamlessly into the current workflow and increase operational efficiency while alleviating administrative workload. 

Transparent business and patient care needs are driving pharmacies to expand their clinical services. Pharmacies need tools and solutions to make adding these services easy to achieve reimbursement from the full spectrum of payors. This includes adding medical billing capabilities 

Putting sound strategies, processes, and solutions in place is imperative to manage medical claims for clinical services via the medical benefit pathway. By augmenting existing workflow and using purpose-built technology, pharmacies can be set up for success today and truly thrive in the future. Adding medical billing capabilities gives pharmacies the most flexibility to exploit new revenue opportunities as pharmacists are granted the ability to deliver a broader array of clinical services. 

Leverage Medical Billing Opportunities to Meet Your Revenue Goals

To learn more about solutions that help pharmacies take advantage of the opportunities presented by expanding clinical services, check out OmniSYS XiFin Pharmacy Solutions, which enables pharmacists to optimize the management of medical claim billing and revenue cycle management for clinical services and specialty drugs covered under the medical benefit within the current workflow. 

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