Pharmacy and Medical Billing

One opportunity for an additional revenue stream is for pharmacists to provide and bill for a multitude of clinical services | Viewpoints | By Patricia Milazzo and Logan Graham

The future of pharmacy is speeding up once again! Pharmacists are providing more clinical services as pharmacy practice shifts away from the primary function of dispensing medication to a growing expansion of clinical services. Pharmacy clinical services may include test-to-treat for COVID-19 or strep throat, routine or travel vaccines, or clinical patient management services, such as smoking cessation or diabetes A1C monitoring. In a single pharmacy encounter, the opportunity exists for medical and pharmacy reimbursement opportunities.

For example, if a patient is seen at the pharmacy and tests positive for COVID but has a contraindication to COVID antivirals, the pharmacy is still eligible for reimbursement of the initial test. Without medical billing functionality, the pharmacy cannot bill for the testing services, and receives zero reimbursement, since no antiviral product is dispensed under the pharmacy benefit.

The Medical Billing Opportunity for Pharmacy

Post-pandemic, primary physician shortages continue to grow, and the pharmacist‘s role during the pandemic, which rapidly expanded, continues to broaden at a significant pace. At the same time, drug reimbursement has shrunk. Pharmacies are closing in many communities, and a crucial need exists for additional revenue streams. One opportunity available is for pharmacists to provide and bill for a multitude of clinical services. A current bill in the U.S. House of Representatives proposes expanding Medicare coverage to permanently include reimbursement for pharmacists who provide clinical services.

With government support, expansion of professional services not only provides a whole new future for pharmacists and opportunities to grow revenue streams, but also brings technology challenges of a new nature.