Pharmacy Blog
When it comes to helping doctors treat their patients, pharmacists are crucial. Furthermore, these services are nothing new to any of us. Since the beginning of the profession, pharmacists have provided services in addition to filling prescriptions. However, receiving payment for services rendered and having effective pharmacy invoicing are two advancements in the pharmacy field.
Furthermore, in order for pharmacies to get compensated for delivering particular treatment, they must utilize medical billing systems. A temporary policy was recently issued by the Centers for Medicare & Medicaid Services (CMS) enabling pharmacists to reimburse Medicare for COVID-19 tests.
An effective pharmacy billing system requires:
If you want to increase the amount of supplemental income you generate, you can consider providing in-office dispensing. There are several things you should be aware of:
Know the Laws in Your State
Every state has its own set of laws, rules, and regulations. A pharmacist may now work with a doctor to give medical services to patients under the laws of various states, but there are guidelines that they must adhere to. For example, the majority of states let pharmacists to adjust prescriptions, control dosages, and oversee medication schedules when needed. They can also offer other services, such as medication monitoring, however they don’t often work with physicians, which may limit the range of diseases and people for which they can offer their services.
Verification of Eligibility Electronically (EEV)
Make sure your patients are covered before providing services to them to save money and time. You may quickly get paid for your services and bill claims effectively using electronic eligibility verification. One of the main benefits of EEV is no phone verification, which guarantees that your phone lines are only released for patient interactions.
Management of Transitional Care
On January 1, 2013, Transitional Care Management, a new Medicare program, was launched as part of the Affordable Care Act. Both physicians and eligible non-physician providers can use this service to bill for care management following a patient’s discharge from an approved nursing facility, an inpatient hospital, or an observation environment.
Since pharmacists are considered non-physician practitioners, only a portion of these services are offered. To be eligible for compensation, a pharmacist would need to submit a claim through a Medicare-approved licensed provider and meet the “incident to” conditions.
Compensation for Preventive Services
While the expenses of delivering pharmacy services under state Medicaid programs vary from one state to the next, the 15 states that provide direct patient care medical payments most frequently cover treatments related to counseling, quitting smoking, and other preventive measures.
CPT codes for medical therapy management
Pharmacists are only permitted to be reimbursed for patient care services under certain negotiation contracts in physician-based practices and non-institutional clinics. It could be necessary to do this by adding CPT codes for “Medication Therapy Management” (MTM).
As an alternative, pharmacist services can be covered via a capitated payment model or pay for performance (PfP) incentives. In the event that no particular contracts with private payers are available, billing for pharmacy services will automatically fall under Medicare guidelines.
Combining Technology with Systems like Pharmacy Management
Technology will play a key role in the healthcare sector. Process automation is a digital journey that can help you reduce stress, costs, and time spent. However, you will create new barriers in the same areas where you were attempting to remove the old ones if your systems are unable to interact with one another.
You are aware of how important it is to record every interaction you have during patient visits and how documentation errors can negatively impact your revenue cycle. Have enough faith that the pharmacy management system and the medical billing solution you select will work together. There’s a potential you’ll have to submit information more than once if the billing system doesn’t integrate, which will
Recognizing the Incident to Billing
While following Medicare’s nine fundamental requirements, a pharmacist who works for a physician-based clinic but is hired elsewhere may charge for their services using the physician-based clinic’s “incident-to billing.”
For patient care services, the US healthcare billing system is extremely intricate and challenging to comprehend, especially for recently graduated pharmacists who are still learning how to charge for their services.
Our team of committed pharmacy billing professionals is prepared to help your clinic optimize its pharmacy billing procedure by utilizing its pharmacy services to generate the most supplemental revenue possible.