Pharmacy billing is the most vital part of every healthcare organization, where a medical service is translated into a billing claim and is submitted to a healthcare insurance company for reimbursement. It is a complex set of procedures which demands a lot of time by skilled professionals. A patient’s medical record is maintained throughout the treatment and after the patient provides the full insurance details to the hospital, the pharmacy billing procedure starts, also referred to as revenue cycle management. Before the pharmacy bill is submitted to an insurance company, the medical treatments or services are allotted a certain alphanumeric code according to a standardized system after which the insurance company decides which part of the claims will and will not be paid. The whole procedure of pharmacy billing is facilitated by a billing software, called pharmacy billing software. There are a number of advantages which a pharmacy billing software offers, which are as follows:
- Quick and easy entry of data without much repetition
- Reduces claim denials
- Tracks and analyzes financial performance
The pharmacy billing software market can be categorized into two major segments, which are as follows:
Electronic health records (EHR) or electronic medical records (EMR) software:
- It is a systematic collection of medical treatment data of an individual patient or a group of patients. The patient data includes demographics, personal statistics such as age, weight, test results, medical history etc.
Revenue cycle management (RCM):
- RCM software ensures reimbursement and reimbursement compliance effectively from start to finish. It provides better access management, improved consumer self-service, streamlined billing process, and an efficient monitoring of insurance companies.
The main driving factors for the growth of pharmacy billing software market are better management of patient’s clinical information and patient’s accounting documentation, processing of insurance claims for a faster reimbursement, and smooth functioning between the healthcare organization and the insurance company (payer). Without pharmacy billing, the hospitals would result in a chaotic environment with disorganized patient information and lack of communication amongst individuals.
Geographically, North America holds a leading position in the pharmacy billing software market followed by the European market. Major factors responsible for the growth of this market in these regions are maintenance of up-to-date and proactive medical service, elimination of billing errors, and the growing need of individuals to access faster reimbursement procedure from the concerned insurance company. Asia-Pacific is one of the most developing regions globally and is emerging out to be a lucrative region for the growth of pharmacy billing software market. The prime factors which will drive the growth of this market in Asia-Pacific regions are increasing need of the population to maximize their insurance payments by proper processing of the provider’s claims, growing demand of individuals to receive the best patient care with regards to medical and pharmacy services, efficient and effective business operations by the healthcare provider, and better denials prevention and management. Moreover, proper maintenance of track of bills and payments for the right information to be recorded will also augment the growth of pharmacy billing software market in the near future.
Some of the major players operating in the pharmacy billing software market are Healthpac Computer Systems, CareCloud Corporation, Kareo, AllegianceMD, Accumedic Computer Systems, NextGen Healthcare Information Systems, LLC, AthenaHealth, McKesson Corporation and many others.
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