Psychiatric Pharmacy Essentials: Practice Reimbursement Resources

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?2-6
    • …in an ambulatory care setting?7-8
    • …in a facility?9
  • How can pharmacy technicians learn more about pharmacy billing?10
    • Billing and reimbursement certificate through PTCB
  • What is “incident to” billing?
    • A ccommon 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?11

Reviewer 1: Claire Herbst, PharmD, BCPS, BCPP
Reviewer 2: Austin Smith, PharmD, BCPP
2024-2025 AAPP Resident and New Practitioner Committee

References

  1. Patient Care Practice Management Community at AAPP. [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.  Scripted. Mastering Pharmacy Medical Billing + Claims Submission. 2024. [Weblink]
  6. CMS. Pharmacy Toolkits: Pharmacy Self-Auditing Toolkit; Pharmacy Prescribing and Billing Toolkit; Off-Label Pharmaceutical Marketing Toolkit. 2024. [Weblink]
  7. ASHP. Pharmacist Billing for Ambulatory Pharmacy Patient Care Services in a Physician-Based Clinic and Other Non-Hospital-Based Environments – FAQ. 2014. [Weblink]
  8. APhA. Billing Primer: A Pharmacist’s Guide to Outpatient Fee-For-Service Billing. 2019. [Weblink]
  9. ASHP. Reimbursement for Clinical Pharmacy Services: Is There a Role for Facility Billing? [Weblink]
  10. Pharmacy Technician Certification Board (PTCB). Billing and Reimbursement Certificate. [Weblink]
  11. ASHP. ASHP Issue Brief: Physician Fee Schedule (PFS) Proposed Rule CY 2022. 2022. [Weblink]