7 basic facts about Pharmacy Billing Services
                     7 BASIC FACTS ABOUT PHARMACY BILLING SERVICES
Physicians delivering healthcare are highly dependent on pharmacists 
to provide better service to patients. Although pharmacists had been 
known for conducting and being reimbursed for product-based 
practices, today, pharmacists play an important role in the healthcare 
delivery system that are needed to meet the goals of the ACA and 
CMS – minimize healthcare costs and improve healthcare delivery.
Pharmacists are improving their reimbursements with many roles and 
avenues, yet clarity in how to improve their Revenue Cycle 
Management (RCM) process is still lacking.
If you are looking to offer in-office dispensing to improve your 
revenue, here are some basic facts when it comes to Pharmacy Billing 
Services.
Read More…
[email protected]         https://www.247medicalbillingservices.com/          888-502-0537
[email protected]         https://www.247medicalbillingservices.com/          888-502-0537
Fact 1.
To enable pharmacist reimbursement for healthcare services, including and 
following the Medication Therapy Management (MTM) CPT codes, negotiation 
specific contracts may be needed in non-institutional physician-based practices 
and clinics. On the other hand, pharmacist-based services may be included in 
pay for performance (PfP) incentives or a capitated payment model. If no 
specific contracts are present with private payers, pharmacy billing services 
automatically default to Medicare regulations.
Fact 2.
When Medicare beneficiaries are seen in a physician’s office by a pharmacist, 
MTM COPT codes are not particularly recognized. Considering that physician 
offices fall under Medicare Part B, this might be the case. Medicare recognizes 
MTM services only under Part D. MTM Services are paid through 
administrative fees to a Prescription Drug Benefit Plan (PDBP) under Medicare 
Part D.
[email protected]             https://www.247medicalbillingservices.com/       888-502-0537
Fact 3.
If another entity has employed the pharmacist but it also practices in a 
physician-based clinic- pharmacists can then charge their services using 
incident -to billing in the physician-based clinic but need to follow the basic 9 
requirements of Medicare.
Fact 4.
As part of the Affordable Care Act, a new Medicare program named Transitional 
Care Management was introduced on 2013 January 1st. The Transitional Care 
Management services are used to bill physician and “qualified non-physician 
providers” care management after an inpatient gets discharge from the hospital 
setting, observation setting, or skilled nursing facility. Pharmacists can serve as 
the “qualified non-physician providers” while offering some of these services. 
Yet, the claim for these services must be submitted under a Medicare 
recognized provider, so here, a pharmacist in this role needs to collaborate with 
a licensed Medicare provider. But, to request reimbursement for these services, 
‘incident-to’ requirements need to follow by the pharmacist.
[email protected]             https://www.247medicalbillingservices.com/        888-502-0537
Fact 5.
A community pharmacy may bill for clinical/cognitive services which may differ by 
state and the Medicare Part D Prescription Drug Plans (PDP) available to them at 
their location. Various states pay community pharmacists to offer multiple levels 
of cognitive services to State Medicaid beneficiaries. But, community pharmacists 
may submit bills to any provider, but they require to decide which providers are 
eligible under a patient’s health insurance plan to submit bills, the rules of 
participation (a participation agreement might be necessary), and then standard 
procedures are to be followed in submitting the bill.
Fact 6.
Pharmacy services payments with state Medicaid programs change from state to 
state. The most common reimbursed services in the 15 states that offer Medicaid 
compensation for direct patient care are counseling, smoking cessation, and 
other preventive services
[email protected]             https://www.247medicalbillingservices.com/        888-502-0537
Fact 7.
The recent legislation passed in multiple states now enables community 
pharmacists to offer clinical services through collaborative protocols with 
physicians. But there are specific rules under which a pharmacist can practice. 
Services such as dosage adjusting and regimens, and medication monitoring, 
and changing prescriptions when required are normally acceptable throughout 
many states except a few. But, there is a narrow scope in the most collaborative 
protocols between a physician and a pharmacist which might limit pharmacist 
clinical services to specified patients and disease states.
Pharmacists need to practice in a range of varied environments and based on 
that, and the CMS rules & regulations, they need to go through the maze of 
billing policies and procedures to help increase their revenues.
We hope these facts will ensure minimal impact on pharmacy billing and coding 
services.
Read more : 
[email protected]             https://www.247medicalbillingservices.com/        888-502-0537
ABOUT US
• We are a medical billing company that offers ‘24/7 Medical Billing Services’ and 
support physicians, hospitals, medical institutions and group practices with our end to 
end medical billing solutions. We help you earn more revenue with our quick and 
affordable services. Our customized Revenue Cycle Management (RCM) solutions 
allow physicians to attract additional revenue and reduce administrative burden or 
losses.
• Our company was founded in 2005 and is now a leading organization of highly 
motivated and certified coders & billers in the US medical billing industry. Our current 
employee strength is 500+ and we have ambitious plans to grow more rapidly.
• As a leading Medical Billing Outsourcing Company we take care of the complete setup 
& enrolment in about one to four weeks time depending on the complexity of the 
project. We have certified trainers with 10+ years of experience to train the 
newcomers so they can get acquainted with the specialty jargons & stay updated with 
the recent coding developments.
[email protected]             https://www.247medicalbillingservices.com/       888-502-0537
CONTACT US
24/7 Medical Billing Services
16192 Coastal Hwy,
Lewes, DE – 19958
USA
Phone no : 
+1 888-502-0537
Email Address :
[email protected] 
[email protected]             https://www.247medicalbillingservices.com/       888-502-0537