Shared visits vs incident-to billing for pharmacy services.

Area of Science:

• Health Services Research
• Pharmacy Practice
• Health Economics

Background:

• Pharmacists offer crucial cognitive services in ambulatory care settings.
• Lack of provider recognition under the Social Security Act impedes independent clinical service billing and reimbursement from national payers like Medicare Part B.

Purpose of the Study:

• To explore the feasibility of "shared visits" between pharmacists and billing providers (e.g., physicians) to increase the level of service (LOS) billed.
• To differentiate "shared visits" from "incident-to" billing models.

Main Methods:

• Analysis of current Medicare billing regulations and guidelines.
• Review of the impact of provider recognition on reimbursement models.
• Examination of documentation requirements for billing purposes.

Main Results:

• "Incident-to" billing, where a pharmacist sees a patient alone under supervision, is limited to the lowest service level (99211) by Medicare.
• Pharmacist documentation does not contribute to determining LOS in shared visits; only the billing provider's documentation is considered.
• Current regulations restrict leveraging combined documentation to increase LOS through shared visits.

Conclusions:

• Despite limitations in shared visit billing, collaboration between pharmacists and other healthcare providers is clinically beneficial.
• Opportunities exist to develop sustainable collaborative care models that address evolving billing requirements and provider documentation.
• Further exploration of billing strategies is needed to optimize pharmacist reimbursement in team-based care settings.