Pharmacists perform a significant role in providing healthcare services to patients. And these services are not a new thing for all of us. Pharmacists have been offering services beyond prescriptions filling for decades from the origin of the profession. However, getting reimbursed for delivered services is one of the developments in the pharmacy profession. Moreover, to get compensated for offering specific care, pharmacies have to take advantage of medical billing services. Recently, Centers for Medicare & Medicaid Services (CMS) enforced a temporary policy for PHARMACY BILLING IN 2020, which allows pharmacies to bill Medicare for COVID-19 tests.
Presently, pharmacists are not known as providers under Medicare Part B. Hence, unable to bill directly for the majority of clinical care services they have been qualified to offer. Nevertheless, via partnerships with other state insurers, healthcare professionals, health systems, and private payers, pharmacists may enforce more effective clinical programs into their practices.
If you are looking to offer in-house dispensing in order to enhance your revenue generation following are some tips that would be effective for successful pharmacy billing:
Electronic Eligibility Verification (EEV)
Consume lesser time and money by confirming your patients possess coverage before you offer services. Electronic eligibility verification permits you to charge claims efficiently and get compensated for your services instantly. One of the key advantages of EEV is no phone verification, which means releasing your phone lines only for communicating with your patients.
State Law Knowledge
Every state has different laws, rules, and regulations. Laws in different states have allowed pharmacists to partner with physicians so that patients can be benefitted from offered medical services, though there are specific regulations that pharmacists should follow. For instance, the majority of the states permit pharmacists to modify prescriptions if necessary and manage dosages and prescription regimens. In addition to this, pharmacists can offer other services, which include examining medication, however, they hardly work together with physicians that can restraint their services to certain patients and disease states.
Preventive Services Compensation
Costs for offering services and pharmacy differ from state to state as per the state Medicaid program. Very popular service repayments for the 15 state providers of direct patient care Medical reimbursement contain smoking cessation, counseling, and other preventive services.
Knowing Incident to Bill
Complying with the nine simple mandates of Medicare, “incident -to billing” can be used by pharmacists who functions with the physician-based clinic but he/she has a job somewhere else in order to bill for their services.
Transitional Care Management
As part Affordable Care Act, on 1st January 2013, a new Medicare program was launched, named “Transitional Care Management”. This service is utilized for billing care management. Furthermore, this service is also used by physicians as well as skilled non-physician providers after discharging patients from the observation unit, an inpatient hospital, and a skilled nursing facility.
Pharmacists come under the non-physician providers category and hence they are offered some sort of these services. Nevertheless, in order to get compensated, a pharmacist requires to meet not only the “incident to” necessities but also he/she should possess a Medicare standard licensed provider submit his or her claim.
Amalgamating with Technology like Pharmacy Management System
Technology is going to be a vital part of the healthcare industry. Automation in processes means a journey towards the digital world that can save your time, money, and stress. Nevertheless, if your systems are unable to communicate with each other then you are going to generate new hurdles in the same in places from where you were trying to eradicate.
As you know the importance of documenting each and every encounter of your patient visit, errors in documenting may impact your revenue cycle. Be confident enough the medical billing solution you select amalgamates with the pharmacy management system. If you’re billing solution fails to integrate there could be chances that you have to enter things a number of times that will increase your workload.
Incorporating MTM CPT Codes
In order to facilitate repayments of pharmacists for patient care services, particular negotiation contracts are needed in physician-based offices as well as non-institutional clinics. This could contain adopting “Medication Therapy Management “(MTM) CPT codes. Each insurer has its own norms for the eligibility of patients for MTM services.
It is your responsibility to recognize these norms to find out the number of patients in your practice expected to qualify given criteria. On the other hand, pharmacist services can be added in pay for performance (PFP) incentives or a capitated payment model. If there are no particular contracts with private insurance companies are available then pharmacy services billing will be directed to Medicare regulations.
Development of Clinical Care Services
As a state-of-the-art pharmacy, you require to assure that your medical billing solution is ready to bill for each care you offer to your patients. You should be prepared enough to bill for various provided care services such as diabetic management, flu shots, durable medical equipment, diagnostic testing, and other immunizations.