At R.J. Hedges & Associates, we believe some of the best ideas come from bringing together trusted experts who share a common goal: helping independent pharmacies thrive. That's the purpose behind our Partnership Series, where we collaborate with industry leaders to provide practical, educational content on today's most important pharmacy topics. In our latest webinar, we welcomed DocStation, a pharmacy-focused medical billing platform, to discuss how pharmacies can identify overlooked reimbursement opportunities while expanding clinical services and enhancing patient care.
Prescription reimbursement continues to tighten. DIR fees, PBM pressures, and shrinking dispensing margins have many independent pharmacy owners asking the same question:
“Where can we find new sources of revenue without completely changing our business?”
The answer may be closer than you think. In fact, you may already be participating in medical billing, you just may not realize it.
One of the biggest takeaways from the discussion was this: many pharmacies are already participating in medical billing—they just may not realize it.
If your pharmacy currently bills Medicare Part B for vaccines, continuous glucose monitors (CGMs), nebulizers, or durable medical equipment (DME), you're already submitting medical claims.
The real question is: Are you capturing every reimbursement opportunity available?
One of the most eye-opening moments of the webinar focused on vaccine billing.
Imagine two patients receiving the exact same high-dose flu vaccine. The pharmacist performs the same work, administers the same vaccine, and completes the same documentation. The only difference is how the claim is submitted.
Many pharmacies automatically bill the patient's prescription benefit. However, if that same patient has a Medicare Advantage (Part C) medical plan, billing through the medical benefit may result in significantly higher reimbursement.
Rachel Matz of DocStation shared examples showing that, across thousands of analyzed claims, pharmacies often saw average reimbursements that were $20–$40 higher for several Medicare vaccines when billed through the medical benefit instead of the PBM.
When administering an immunization, there are two distinct billable components:
• The vaccine product itself
• The professional service of administering the vaccine
Preparing the patient, reviewing contraindications, administering the injection, and monitoring the patient afterward are valuable clinical services. Depending on the payer, pharmacies may have opportunities to receive reimbursement for the administration component in addition to the vaccine itself.
Medical billing opportunities may also include Medication Therapy Management (MTM), Diabetes Self-Management Education and Support (DSMES), Point-of-Care Testing, Chronic Care Management, immunization administration, DME, CGMs, and nebulizer medications, depending on payer rules and state regulations.
Successfully expanding medical billing starts with having the proper credentials in place, including Medicare PTAN enrollment, the appropriate CMS applications (855B or 855S), credentialing, billing knowledge, and clinical workflows.
R.J. Hedges & Associates helps pharmacies navigate Medicare enrollment, PTAN applications, compliance, and accreditation, while DocStation provides the technology platform for medical billing, clinical documentation, patient workflows, and revenue tracking.
Interested in learning more? DocStation helps pharmacies streamline medical billing, manage clinical workflows, and identify reimbursement opportunities for services such as immunizations, consultations, point-of-care testing, and DME. Want to see these concepts explained in more detail? Watch the full Partnership Series webinar with DocStation "Lifting the Veil on Medical Billing", now available on demand.
DocStation
Website: https://docstation.co
Schedule a Consultation: calendly.com
R.J. Hedges & Associates
Website: https://www.rjhedges.com
Contact: sales@rjhedges.com
The R.J. Hedges Partnership Series brings together trusted industry experts to share practical strategies, innovative solutions, and educational resources that help independent pharmacies strengthen operations, remain compliant, and discover new opportunities for growth.
Stay tuned for future webinars featuring leading organizations serving the independent pharmacy community.