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Like how other areas in healthcare get affected due to poor medical billing and coding, pharmacy billing is no less than any. Surveys say that most pharmacies incur huge losses as there are several challenges encountered that lead to a loss in revenue. With constant changes in healthcare and increasing demands, pharmacies are also experiencing the force.

Since many pharmacies are attached to medical practices, in the beginning, you may not feel the heat, but in the bottom line, there are plenty of challenges that affect pharmacy reimbursement straight. Today, we will see the top billing challenges that a pharmacy encounters and also some best practices to overcome those challenges.

Challenges faced by Pharmacy in Medical Billing

  • It is very difficult to identify and understand the roles and responsibilities of the pharmacy staff during billing.
  • While billing, pharmacists may not document the required codes for drugs and it may result in confusion during claims.
  • Your staff may not have enough resources to get the updated information and training about different drugs and their codes upfront.
  • The billing system of your pharmacy may not be updated with the latest government rules and codes for new and several other drugs.
  • Your staff may not be aware of which set of drugs, injections, and therapies are covered by the payer. Therefore, it requires an expert’s intervention to assess whether it is worth including or excluding them while billing.
  • During billing, your staff may not be able to focus on providing quality customer service due to time spent on billing looking for codes.
  • The billing system followed by your pharmacy may not be to the latest technology introduced, which results in a delay of patients’ billing.
  • Many pharmacists may not be aware that sometimes vaccine claims are not covered in the medical billing process. Without knowing, your staff may submit claims which result in a waste of time.
  • Due to a high number of missing information, lack of updated drug codes, or missing records, claim denials occur frequently in pharmacy billing.
  • If you follow incorrect charge description master (CDM), it could result in underpayment, claims denials, and fines.
  • An in-house billing system maintained by pharmacies may not be scalable.
  • If you have a shortage of workforce, it could lead to a huge waste of time and energy during billing, especially when handling critical cases.
  • It becomes difficult for pharmacies to get access to patients’ eligibility during billing may be unavailable.

Best practices can be followed for seamless functioning

  • You should deploy centralized IT systems that help you with minimizing duplication of work and errors during billing.
  • Your staff should have up-to-date knowledge and information about changing government rules and regulations and drug codes, and it should be incorporated as a policy in your billing system.
  • It is ideal to integrate your inventory management with your pharmacy billing system.
  • Ensure you have everything automatized that reduces errors and claim denials.
  • Your staff should be regularly trained on constantly changing codes and rules so as to avoid blunders in medical billing.
  • Make sure your billing system is flexible and highly scalable.
  • Delegate tasks according to skills; therefore, it ensures proper communication between you and your insurer.
  • Provide the right information to your patients on insurance coverage so that there will not be any confusion in your medical billing and patients are also taken care of with good customer service.


Pharmacy medical billing can be quite challenging for pharmacists since it involves a lot of drug codes and proper rules to be known before claiming insurance. Although these best practices can give you a streamlined pharmacy medical billing system, the amount you invest in rolling out all these best practices can cost you your capital amount. Therefore, outsourcing your pharmacy billing services to a third-party medical billing service provider can save your time, effort, and money in many aspects.

Moreover, you will have dedicated teams for handling every process of medical billing and coding, making it easy for your staff to focus on patients and improvise your revenue to the core. If you are looking for a top medical billing outsourcing company, you can contact 24/7 Medical Billing Services, an expert in providing top-notch medical billing and coding services at affordable prices. We cover every pain point of your pharmacy billing and offer highly scalable and flexible solutions for your benefit.

Contact 24/7 Medical Billing Services at +1-888-502-0537 or drop an email to us at info@247medicalbillingservices.com or visit our website www.247medicalbillingservices.com for more information on pharmacy medical billing services.


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