A lot of specialty pharmacies consider hiring specialty pharmacy billing as a costly venture for their practice. The reality is that outsourcing specialty pharmacy can be a smart move for expanding the business.

Think about how you can benefit from their services. Your busy staff won’t need to spend hours copying records, as most can be managed remotely with secure systems. Professional specialty pharmacy billing specialists will ensure claims are correctly coded and submitted on time. They also handle patient queries, allowing your staff to focus on providing the best patient care.

With many specialty pharmacy billing companies available, finding the best revenue cycle management partner can be overwhelming for you.

Before choosing a billing partner, consider the following key factors and evaluate each company based on their responses.

Critical factors to consider when selecting a specialty pharmacy billing company

1) Certification:

Having staff with adequate specialty pharmacy billing knowledge is essential for the outsourcing partner. You can determine if the billing experts are properly qualified by checking their certification. Certifications like CPC, CPC-H, CCS-P, CCS, RCC, and OTR ensure that the billing experts are qualified to handle your process.

2) Experience:

Medical billing companies have experience in many medical specialties. When you are hiring a billing partner, make sure they have a considerable amount of experience in handling specialty pharmacy billing. The billing company should know how to handle all the coding nuances associated with your specialty pharmacy. Know how they handle payer follow-ups, what communication platforms they use, how they handle denials, etc.

3) HIPAA Compliance:

Ensure the company strictly follows HIPAA regulations. Many medical billers claim to understand HIPAA but may not fully grasp the consequences of violations. Before hiring, verify their commitment to handling information properly to prevent any leaks of sensitive data.

4) Willingness to understand:

The specialty billing company that you are going to select should always walk the extra mile to understand your unique style of operation. If the billing company fails to understand your process, you will encounter a lot of issues eventually.

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Learn About the Key Benefits of Outsourcing Specialty Pharmacy Billing

Outsource specialty pharmacy billing to reduce errors and boost revenue. Improve cash flow and productivity with Sunknowledge. Learn more today!

Knowledge about different payers:

Each payer has its own set of guidelines, so it’s essential to review contracts carefully to understand the terms, rates, and conditions. This helps avoid unexpected issues later. Your biller should be familiar with the fee schedules and payer contracts specific to your specialty pharmacy to significantly improve your collections.

Now that you understand the critical factors to consider before hiring a billing company, it’s time to act. Hire Sunknowledge’s specialty pharmacy billing experts to enhance your front-end process. Streamline your revenue cycle with their seamless, versatile support across all practice management systems.


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