Pharmacy Revenue Cycle Management to Boost Clinical Billing

In this episode of Medical Billing Decoded, Jennifer Griffin, PharmD, a clinical pharmacist with Harps Food Stores, and Duane Jones, BSPharm, clinical director for Harps Pharmacies, offer a practical, technician-driven roadmap for revenue cycle management (RCM) that helps community pharmacies bill and get paid for clinical services without hiring extra staff or outsourcing to third parties.

Griffin, who manages medical billing across 37 pharmacies in 3 states while still working regular pharmacy shifts, began by demystifying the concept.

“Revenue cycle management, or RCM, is such a buzz phrase,” she said. “It’s the piece of providing clinical services that can be overwhelming to people, but once you break it down, it’s something that’s very manageable.”

She positioned RCM not as an abstract administrative burden but as a concrete, learnable workflow that any organized pharmacy can implement.

Jones underscored the strategic importance of owning billing processes as pharmacists’ clinical roles expand. He argued that pharmacies can no longer afford to rely on others for billing and contracting.

“If we start to embrace this and understand it and learn it, we’re now in control of our future,” he explained. “No reason to pay somebody else to do this and give away your profits. Embrace it, pull it into your workflow, and make it part of your daily business structure.”

He linked this directly to broader trends in health care, including rural access challenges and the push toward provider status for pharmacists.

A central focus of the conversation is workflow design and the pivotal role of pharmacy technicians. Griffin emphasized that technicians, not pharmacists, carry most of the operational load. By promoting an appointment-based model and leaning on well-trained technicians, Harps has integrated clinical services into the existing pharmacy workflow without adding staff.

To make the process tangible, Griffin walked through a common scenario: a patient coming in for a strep test office visit. Technicians verify eligibility and benefits using payer portals, determine the patient’s copay or deductible, and collect payment at the time of service while clearly explaining that the final amount may adjust once insurance pays. Claims are then created and submitted through the pharmacy management system using CPT codes, just like prescriptions. Griffin’s team relies on “billing blanks,” simple paper or digital cheat sheets that specify exactly which codes and details are needed for each service, from strep tests to vaccines and A_1C testing. This standardization allows technicians to move quickly and accurately with minimal retraining as new services are added.

On the back end, Griffin devotes about an hour per week to reconciling rejections and denials across all 37 pharmacies. Most issues stem from basic data-entry mistakes, such as a mistyped member ID or a name that does not match the insurer’s records. A straightforward spreadsheet tracks every claim and its status, giving the team full visibility without the cost or complexity of dedicated billing software. Over time, this data becomes a tool for analyzing reimbursement patterns, checking whether the pharmacy is being paid correctly, and catching trends in recurring errors that signal a need for retraining.

Jones repeatedly called on pharmacists to stop undervaluing their services. “We’ve given away our services for so long that I hear pharmacists say, ‘I feel bad about asking them to pay,’” he said. “They’re accustomed to coming in and paying for services. We need to get accustomed to charging for those services.”

He also pointed out that maintaining consistent cash prices aligned with billed amounts is critical for contractual compliance and future Medicare provider status.

Both Griffin and Jones frame the current moment as a preparation window for expanded clinical practice.

“This is your 6- to 8-month window,” Jones said. “Once you learn it and you understand it, you’re in control of your future.”

Griffin closed by urging pharmacists to start now, even with low patient volumes, so they are ready to scale. “Start now, set up your process in your pharmacy,” she said. “It’s going to be so cool to sit there and say, whenever I’m allowed to implement a new service, I know how I’m going to do it, and we’re ready to go.”