This product is an ASHP Learning Center https://elearning.ashp.org/ activity.
Overview
The Billing and Reimbursement for Patient Care Clinical Services Certificate is designed for pharmacists who provide clinical services in various practice settings, as well as for individuals involved in billing for these services. Mary Ann Kliethermes, BSPharm, PharmD, FAPhA, FCIOM, a recognized expert in the reimbursement of pharmacist care services, serves as the editor of this unique and comprehensive resource. The curriculum covers a range of topics, including, but not limited to, the following:
- Language of healthcare billing
- Reimbursement models, including fee-for-service and value-based care models
- Medicare, Medicaid, and commercial insurance payers
- Rules related to eligibility of healthcare professionals to bill for services
- Collaborative practice agreements
- Medical vs. prescription benefits
- Payer mix
- “Incident to” as a billing mechanism
- Facility fee billing
- Care management services – chronic care, principal care, and transitional care
- Medicare Annual Wellness Visits
- Medicare Diabetes Prevention Program and Diabetes Self-Management Training
- Medication Therapy Management
- Continuous glucose monitoring and home INR monitoring
- Telehealth
- Reimbursement in federally qualified health centers (FQHCs) and rural health clinics (RHCs)
- Pharmacist prescribing and reimbursement opportunities at the state level
- Building the business case for pharmacist patient care clinical services
- Outside opportunities to fund patient care clinical services
- Preparing for successful implementation and growth of services
- Engaging with commercial insurance payers to be reimbursed for patient care clinical services
- Healthcare billing cycle
- Electronic billing
- Managing claims before and after adjudication
- Staying current with billing and reimbursement rules and opportunities
Billing and Reimbursement for Patient Care Clinical Services Certificate Requirement
Once a learner has completed the educational curriculum, they will have the opportunity to complete an online comprehensive exam. Once the learner passes the exam (minimum 80% passing rate; unlimited attempts permitted), they will earn the professional certificate.