Understanding the reimbursement model of a practice is often vital to growing new models. Information on this topic can be found in the Patient Care Practice Management (PCPM) Community. The community discusses innovative inpatient and outpatient practice models with a focus on sustainable practice development, protocols, documenting outcomes and demonstrating value to stakeholders.

  • Where can I learn more about sustainable practice models and reimbursement?1
  • What are some references I can use for how to bill?2-4
    • …in an ambulatory care setting?5
    • …in a facility?6
  • How can pharmacy technicians learn more about pharmacy billing?7
    • Billing and reimbursement certificate through PTCB
  • What is “incident to” billing?
    • A common approach to billing in these settings is “incident to” billing where the practitioner or clinic bills for the services of the pharmacist “incident to” the practitioner or clinic service. The billing entity receives payment and reimburses the pharmacist.
  • What does the physician fee schedule with the Centers for Medicare & Medicaid Services (CMS) have to do with pharmacist billing?8-9

References

  1. Patient Care Practice Management Community at CPNP. [Weblink]
  2. American Society of Health-System Pharmacists (ASHP). Pharmacist Billing/Coding Quick Reference Sheet For Services Provided in Physician-Based Clinics. 2019. [Weblink]
  3. American Pharmacists Association (APhA). Billing & Payment Center. [Weblink]
  4. National Council for Prescription Drug Programs (NCPDP). Billing Guidance for Pharmacists’ Professional and Patient Care Services. 2018. [Weblink]
  5. ASHP. Pharmacist Billing for Ambulatory Pharmacy Patient Care Services in a Physician-Based Clinic and Other Non-Hospital-Based Environments – FAQ. 2014. [Weblink]
  6. ASHP. Reimbursement for Clinical Pharmacy Services: Is There a Role for Facility Billing? [Weblink]
  7. Pharmacy Technician Certification Board (PTCB). Billing and Reimbursement Certificate. [Weblink]
  8. CMS. Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021. [Weblink]
  9. ASHP. ASHP Issue Brief: Physician Fee Schedule (PFS) Proposed Rule CY 2021. 2020. [Weblink]
25 Years!