Specialty Pharmacy Medical Billing: What You Need to Know
Specialty drug growth is accelerating—and hospital outpatient pharmacies are uniquely positioned to capture the opportunity. These high-value therapies now represent 52% of total drug spend and 70% of the pipeline, while 340B continues to expand 15–20% annually. Yet specialty pharmacy medical billing has never been more complex.
Many organizations rely on traditional billing systems that aren’t designed for specialty workflows. Medical benefit claims, complex prior authorizations, 340B modifiers, and rapidly evolving payor policies strain operations driving denials, revenue leakage, and compliance risk.
In this on-demand webinar, industry experts explore the revenue cycle, market access, and technology capabilities needed to modernize specialty pharmacy medical billing, reduce denials, and scale sustainably in a rapidly changing payor environment.
What You’ll Learn:
- Real-world examples of streamlining medical benefit billing for specialty drugs
- How payor behavior impacts market access, contracting, and reimbursement
- Strategies to prevent denials using AI-enabled, exception-driven workflows
- Ways to maximize 340B opportunities while maintaining compliance
- How AI can improve accuracy, speed, and staff productivity
- What future-ready billing and revenue integrity infrastructure looks like, and how to build it
Moderator
David Pope, PharmD
Chief Pharmacy Officer
XiFin, Inc.
David Pope is the Chief Pharmacy Officer of XiFin, Inc. As a pharmacist, Dr. Pope is dedicated to improving patient care through innovative ideas. He brings over two decades of experience in pharmacy consulting, medical informatics, transitions of care, publications, independent pharmacy practice, and integrating clinical services in the retail pharmacy space. Before joining XiFin, David helped co-found STRAND Clinical Technologies, the U.S. market leader in helping pharmacists launch clinical services within their community. Pope holds a Doctor of Pharmacy from the University of Georgia.
Speakers
Heather Agostinelli
Vice President and Head of Specialty RCM
XiFin, Inc.
Heather Agostinelli is Vice President and Head of Specialty RCM at XiFin and is responsible for executive leadership and administration of expansive pathology, pharmacy, and laboratory operations. With over 25 years of experience explicitly dedicated to diagnostics and pharmacy revenue cycle management and 29 years in the healthcare industry, Heather has amassed an extensive knowledge base, implementing/managing RCM best practices and delivering operational excellence. Heather has worked closely with the executive leadership teams of the country’s top clinical, outreach, and independent laboratories to share her RCM proficiencies and run their RCM processes with her team.
Mike Fauver
VP, Enterprise Solutions
XiFin, Inc.
Currently the Vice President of Enterprise Solutions at XiFin, Mike helps drive sales, product development, optimization, and execution of the revenue cycle management solutions including XiFin RPM. Mike has more than 20 years of hands-on industry experience in revenue cycle management, billing and receivables management, and IT expertise. Prior to joining XiFin, Mike was Manager of Revenue Cycle at Mayo Clinic Laboratories. He has also held roles as a Sr. Systems Analyst and Business Office Coordinator. Mike holds a BS in Business Management from Minnesota State University, Mankato, as well as an MBA in Finance from the University of Wisconsin-Whitewater.
