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Related Experiment Videos

Billing third party payers for pharmaceutical care services

S Poirier1, D E Buffington, G A Memoli

  • 1College of Pharmacy, University of Georgia, Athens, USA.

Journal of the American Pharmaceutical Association (Washington, D.C. : 1996)
|February 17, 1999
PubMed
Summary

Pharmacists can get reimbursed by third-party payers for pharmaceutical care services by following specific billing steps. Understanding the process can increase successful compensation claims.

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Area of Science:

  • Pharmacy Practice
  • Healthcare Reimbursement
  • Health Services Research

Background:

  • Pharmacists are increasingly providing patient care services beyond dispensing.
  • Reimbursement for these services from third-party payers is crucial for practice sustainability.
  • Many pharmacists lack the knowledge to navigate the billing process effectively.

Purpose of the Study:

  • To outline the essential steps for pharmacists seeking reimbursement from third-party payers for pharmaceutical care services.
  • To provide guidance on overcoming common barriers to successful claims.

Main Methods:

  • Review of government and professional publications, including manuals and newsletters.
  • Incorporation of authors' practical experience in navigating third-party payer systems.

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Main Results:

  • Successful reimbursement requires preparatory actions: obtaining provider numbers, claim forms, and establishing fee structures.
  • Accurate claim submission involves collecting patient insurance details, physician statements, and complete documentation.
  • Initial claim rejections are common but can be overcome by addressing payer feedback and resubmitting claims.

Conclusions:

  • Adherence to outlined billing guidelines can lead to a higher rate of successful claims for pharmaceutical care services.
  • Systematic approach to billing enhances pharmacists' ability to secure compensation from third-party payers.