Impact of medical billing education support on billing practices in Arkansas community pharmacies

Third-party insurers allow pharmacists to bill medical claims for patient care services, per statewide protocol, in Arkansas. This means community pharmacists in Arkansas can be compensated for patient care services. However, many face challenges navigating the medical billing process to obtain reimbursement.

This study evaluates the effectiveness of educational support-on-site visits, medical billing bootcamps, and continuing education-on implementation of medical billing in Arkansas community pharmacies.

A retrospective analysis was conducted using data from Arkansas Community Pharmacy Enhanced Services Network (AR CPESN) and Arkansas Pharmacists Association (APA). The AR CPESN surveyed representatives from 185 pharmacies from May to June 2024, assessing their implementation of billing practices. The survey asked about types of covered services offered, pharmacist credentialing, and billing methods. APA supplied pharmacy participation in medical billing bootcamps, on-site visits, and continuing education presentations. Data were analyzed using Pearson chi-square test and logistic regression to determine the relationship between educational support efforts and billing practices.

Participation in medical billing education support efforts did not show a statistically significant correlation with billing practices. Pharmacies with credentialed pharmacists were more likely to offer cash-based services and bill Arkansas Blue Cross and Blue Shield (p < 0.001). Of 185 pharmacies surveyed, representatives from 161 pharmacies responded (87%). Among these, 85 pharmacies (53%) provided at least one service under the Arkansas statewide protocol. Of the pharmacies providing services, 70 (82%) had credentialed pharmacists, 74 (87%) offered cash-based services, and 41 (48%) billed medical claims to Arkansas Blue Cross Blue Shield.

Arkansas community pharmacies began adopting protocol-based services soon after statewide policies took effect, nearly half submitting medical claims within the first year. Pharmacies already offering cash-based services or employing credentialed pharmacists were more likely to bill medically, suggesting implementation progresses as workflows mature. Ongoing evaluation of service delivery and billing practices will be essential to sustainable integration of pharmacist-provided clinical services.