Many medical billing agencies are actually full blown stores that do over the counter and prescription sales. Because this isn't a standard practice, this functionality is usually considered an add-on when purchasing your DME software. Not only is the software portion an add-on but there is some hardware that comes with it as well. We're going to give a brief overview of the retail sales setup so billers will know how they work and how they tie in with the medical billing procedure.
In a typical medical billing procedure, the patient had some work done off site at a facility or doctor's office. The agency then gets the bill on behalf of the patient and sends it to the insurance carrier for payment. In the case of retail sales, usually what happens is that the doctor will prescribe some kind of medication or even a device. The patient will then take the prescription to the retail establishment, where the billing also takes place and has the prescription filled. The retail section will enter the prescription into the DME system through the retail sales module.
This is done by actually scanning the item through the barcode reader, which is something that most retail establishments have today. Very few stores actually punch in prices by hand anymore. After the item is scanned, it goes into the system and a bill is created. The patient is given a receipt for the purchase. In this case, one of two things has happened. Either the retail center knows the item is covered under insurance and no charge is made to the patient, or it needs to be determined if the item is covered and the patient pays for the item up front.
After this happens, the medical billing staff get the retail sale sent to them on their end. They then pull up the patient information, just like they would do for any other bill and create the work order that will ultimately be sent to the carrier. After this is done, a check is sent to the biller, if the item is covered and then the biller pays the patient. Of course, the check the biller gets is more than what the patient actually gets. Usually there is a copay. In this way the biller does make some small profit. Otherwise there is no point to doing this.
The equipment used for this process is fairly standard. The retailer has a scanner and a ticker. The ticker is what prints out the receipt for the patient. The hardware part must be connected to a computer that is also running the DME software, otherwise the retail sale itself will never make it to the billing staff.
Retail sales and medical billing are becoming more and more common as we get into the twenty-first century. In the United States there are a number of chains that participate in retail sales and medical billing in combination. As we get more and more automated, the number of these establishments is certain to grow. Eventually, you'll be able to go just about anywhere to have your prescription filled and a bill sent to Medicare at the same time.
