Medical Billing vs. Pharmacy Billing – Are You Making This Mistake?

What this video covers

The video compares the two billing systems side by side: code sets, adjudication timing, payer types, and where each applies. It is aimed at practices that dispense in-house, infusion clinics, and pharmacy owners whose teams cross between both worlds and keep losing revenue at the boundary between medical and pharmacy benefits.

• Different code sets. Medical claims use CPT and ICD-10 while pharmacy claims use NDC numbers, and mixing them causes automatic rejections.
• Different adjudication speed. Pharmacy claims adjudicate in real time at dispensing, while medical claims can take days or weeks to process and pay.
• PBMs versus payers. Pharmacy benefit managers set their own rules, contracts, and reimbursement logic, separate from anything the medical plan requires.
• Buy-and-bill decisions. Drugs administered in the office may belong on the medical benefit, and choosing wrong changes reimbursement significantly.

Staffingly staffs billers who work both medical and pharmacy claims daily, so drugs land on the correct benefit the first time. Dedicated teams come with a signed BAA, HIPAA and SOC 2 Type II compliance, US-based account management, and flat weekly pricing from $399. Learn more about Staffingly’s LTC & Retail Pharmacy services.