Reimbursment for Clinical Services
Key Points
Pharmacists are currently unable to submit claims to insurance companies for reimbursement of clinical services, such as contraceptive counseling and prescribing.
The clinical capabilities of pharmacists stretch beyond that of contraceptive products; more opportunities to receive reimbursement will enable broader services and patient care.
What is the issue?
Provider Status – Pharmacists are trained to provide immunizations, medication therapy management consults, smoking cessation, point-of-care tests, and many other supportive services. Problem – Lack of provider status prevents insurers from considering pharmacy consults as a necessary and billable service.
Unclear Billing Methods – Billable services to insurers can occur directly or indirectly to receive reimbursement. Determining if services are billed under medicare Part B versus Part D create another layer of complication. Problem – Billing to insurers is complex, creating limitations to different areas of pharmacy and can restrict adequate reimbursement from occurring.
Establishing clear billing codes and methods to encompass the diverse clinical services pharmacists can provide will expand the scope of pharmacy practice, creating more accessible care.
Next Steps for Indiana
Pass legislation that prevents insurance companies from denying reimbursement to pharmacists who complete services, within their scope, that would routinely be reimbursed if performed by another healthcare practitioner.