Medical Billing and Outsourcing: A Quick Win to Mitigate Staffing Shortages in Pharmacies

Pharmacies are undergoing a significant transformation driven by expanding scopes of practice. Staffing and financial pressures, however, continue to impede progress.

According to the 2025 XiFin Pharmacy Transformation Outlook Survey, pharmacy leaders ranked staffing shortages, workload, stress and burnout, and time constraints among pharmacies’ top five challenges, echoing a growing call for more sustainable operations.

Research respondents indicated that pharmacists’ increasing workloads often do not result in corresponding revenue increases. Some respondents expressed worries about staff shortages and the potential for more work with the introduction of new technologies and the increasing shift toward medical benefit billing for clinical services and specialty pharmacy.

Meanwhile, reimbursement remains the #1 barrier to expanding pharmacy services, with 63% of research participants citing it as a top obstacle. Collection rates under 49% are still common for clinical services delivered. These barriers hinder the ability to scale services such as specialty pharmacy, particularly in emerging areas like infertility, hepatitis C, and sleep disorder treatments, which pharmacies expect to grow in the next 12–36 months.

It’s clear: to pursue new opportunities like clinical care expansion or specialty pharmacy growth, pharmacies must first tackle the operational challenges that stand in their way, starting with medical billing or revenue cycle management (RCM).

The Pathway to Relief: Optimizing Revenue Cycle Management

To overcome these hurdles, pharmacies must thoroughly examine their systems and workflows. Streamlining RCM or medical billing processes creates a foundation that supports service expansion, improves financial health, and reduces staff strain. Optimizing the revenue cycle alleviates staffing and economic pressures. Finding new efficiencies and accelerating time to reimbursement provides a clear financial payoff.

A modern, pharmacy-focused RCM strategy can:

• Accelerate reimbursements through automation and real-time eligibility verification
• Reduce denied claims and manual follow-ups by improving claim accuracy
• Uncover insights using AI-driven analytics to track payor behavior, collections, and contract variances
• Reclaim staff time and reallocate talent toward clinical care and patient engagement
• Automate medical billing, which 55% of survey respondents cited as a barrier to growth

You can use these cost savings and increased reimbursements to help address staffing shortages, reallocating dollars toward recruitment, retraining, and salaries to attract and retain personnel.

Outsourcing Pharmacy RCM: Accelerating ROI

While in-house billing may work for traditional medication dispensing and claims processing via the pharmacy benefit, clinical and specialty services often require medical billing, which introduces new billing codes, documentation requirements, and payor expectations. And in today’s staffing climate, training or hiring skilled medical billing professionals isn’t always feasible.

Outsourcing all or part of your pharmacy RCM process offers:

• Expertise in medical billing and specialty pharmacy reimbursement, including J-code tracking and 340B claim support
• Faster cash collections and improved claim performance, especially for high-volume, lower-margin services
• Built-in scalability to support new clinical offerings without overloading your team
• Seamless technology integration, connecting pharmacy systems to payor workflows, and reducing manual entry

In today’s challenging financial climate, where pharmacies must be exceptionally agile and adaptive, outsourcing all or part of the RCM or medical billing process allows you to delegate the high-volume, lower-value work and the pain of keeping up with changing regulations and payor requirements. It also complements your team with a knowledgeable companion resource, especially when locating the appropriate medical billing skillset or expertise within your community proves challenging. It allows reallocating staff to more complex, higher-value, patient-facing work. And if your financial needs are especially urgent, it provides the speediest path to ROI.

The Opportunity Ahead

Despite the challenges, pharmacy leaders remain optimistic: 72% of Pharmacy Transformation Survey respondents identified an expanded role for pharmacists in filling primary care gaps as the top growth opportunity. And 34% expressed confidence in pharmacy’s ability to improve access, equity, and outcomes through expanded clinical care.

Yet opportunity only becomes a reality when operational infrastructure can support it. A purpose-built RCM solution tailored to a pharmacy’s unique billing environment is no longer a nice-to-have—it’s essential for any pharmacy looking to grow while navigating today’s headwinds.

Staffing constraints and low reimbursement limit today’s pharmacy operations and jeopardize tomorrow’s growth. By modernizing RCM workflows and considering outsourced billing support, pharmacies can reclaim time, improve margins, and confidently expand their clinical and specialty pharmacy offerings.

There are several paths to quick wins. Outsourced billing services can help augment your team while realizing billing and process efficiencies, accelerating cash flow, mitigating staffing challenges, and improving margins. They also increase cash collections, create better patient experiences and engagement, improve claims management, and optimize workflows.

Our e-book, Auditing the Complexities of Medical Billing for Clinical Services and Specialty Pharmacy, gives you more insight into the complexities of RCM and reveals key areas for improvement in your revenue strategy.