Advancing The Profession of Pharmacy

Professional Preparation for Medical Billing as a Pharmacist Provider

by | Apr 9, 2024 | Consulting Pharmacist Education

CMS Billing Updates for 2022

After six months of navigating medical billing as a pharmacist provider, there are three things I recommend every pharmacist can do for themselves today in preparation for delivering clinical consultation services in the future.

I expect trends to continue to reflect the importance of the expansion of pharmacist-led services, however, there are things we can do to prepare professionally as we wait for provider status at the federal level.

 

1. Get credentialed with participating payers.

As providers, pharmacists can receive reimbursement for consulting services using the office visit CPT codes through payers. Documenting and billing for clinical services was a challenge when I first began offering MTM services as a consultant pharmacist in 2015.

Today in Arkansas, Blue Cross & Blue Shield is reimbursing for E/M codes delivered in the community pharmacy setting via test and treat services for flu and strep protocols.

Most surprising in the data, for me, was the number of patients without a primary care provider and the number of pediatric patients being tested.

I look forward to seeing what the data from AR BCBS uncovers!

 

2. Understand your state’s pharmacy practice act.

The Pharmacy Practice Act outlines the pharmacist’s scope of practice as a licensed professional in a particular state.  This helps licensed pharmacists understand the full capabilities of their license and gives them the ability to practice to the extent of their knowledge and license. 

The devil is in the details and state regulations wildly vary.  Obtaining provider status at the federal level will help to streamline the consultant pharmacist model in the future, however, current innovation is limited by or expanded on a state-by-state policy.

Kentucky is an example of a state that has passed dozens of statewide pharmacy protocols.

 

3. Explore opportunities for consulting.

As the profession of pharmacy continues to evolve with the changing healthcare landscape, the National Health Service in the UK took an unprecedented step in January 2024.

“The Pharmacy First Service builds on the previous Community Pharmacist Consultation Service (CPCS) by enabling community pharmacies to manage patients for seven common conditions, following specific clinical pathways.”

There are hundreds of clinical programs being delivered by pharmacist providers and more to be developed by innovative pharmapreneurs.

Want to join me in advancing the practice of pharmacy?

 

Join the Pharmapreneur Academy Newsletter for Career and Business Development:

  • Pharmacy Scope of Practice Requirements for Medical Billing
  • Credentialling with Payers: From Application to Acceptance
  • Selecting Lab Technology and Obtaining CLIA-waiver Certification

About the Author

Blair Thielemier, PharmD, is a business development consultant specializing in pharmacist-led billing models. She has set the industry standard for virtual pharmacy conferences with the Elevate Pharmacy Virtual Summit in 2017. She has consulted with national pharmacy organizations, drug wholesalers, point of sale companies, and Fortune 5 health insurers. She has books and online courses available for individuals looking to leverage their pharmacy knowledge into monetized clinical programs at PharmapreneurAcademy.com She speaks internationally about trends in leveraging pharmacists to improve value-based care.

 

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