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Getting Paid for Clinical Services.

Caren McHenry Martin

    The Consultant Pharmacist : the Journal of the American Society of Consultant Pharmacists
    |May 24, 2018
    PubMed
    Summary

    Pharmacists offer advanced clinical services but face reimbursement barriers due to Medicare inclusion issues. This necessitates exploring alternative avenues for pharmacist compensation and patient care.

    Area of Science:

    • Health Services Research
    • Pharmacy Practice
    • Health Policy

    Background:

    • Pharmacists are increasingly delivering advanced, patient-centered clinical services.
    • Current healthcare policy, specifically the Social Security Act, excludes pharmacists from Medicare billing and reimbursement.
    • This exclusion impacts the ability of pharmacists to be reimbursed for clinical services by many state and private health plans.

    Purpose of the Study:

    • To examine the challenges pharmacists face in obtaining reimbursement for clinical services.
    • To explore the implications of Medicare exclusion on pharmacist-provided patient care.
    • To identify alternative reimbursement strategies for pharmacists.

    Main Methods:

    • Policy analysis of the Social Security Act and its impact on pharmacist reimbursement.

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  • Review of current practices and challenges in pharmacist billing and reimbursement.
  • Exploration of innovative models for pharmacist compensation and service delivery.

    • Main Results:

    • Pharmacists are not recognized as eligible providers in key Medicare statutes.
    • This omission is widely used as justification for denying reimbursement for pharmacist clinical services.
    • Alternative reimbursement strategies are being sought by pharmacists to ensure patient care continuity.

    Conclusions:

    • The exclusion of pharmacists from Medicare reimbursement structures limits their ability to provide and be compensated for advanced clinical services.
    • Innovative approaches are needed to secure reimbursement for pharmacists.
    • Addressing policy barriers is crucial for integrating pharmacists into broader healthcare payment models.