As many pharmacies hoping to expand their clinical practice are aware, there are limits and requirements that must be overcome to receive reimbursement for all the services they perform for their patients. (What?? Extra hoops to jump through–for pharmacists?? No way!) For example you’ve set up your clearinghouse, you’ve gotten your PTANs and contracting done, but you still can’t bill for DSME because you aren’t accredited as a diabetes educator. Or perhaps your practice includes chronic care management but you can’t bill for those CPT codes, although you should definitely be paid for the impact you have on patient lives and healthcare costs in general. You read about the possibility of setting up a collaborative practice agreement (CPA), but haven’t found much guidance on actually getting it done.
Even in states which have restrictive provider status (not saying names–you know who you are), there are ways to ensure pharmacies are paid for the invaluable services they provide.
We’re always looking for opportunities to innovate our network and provide more services for pharmacies growing their clinical practice. We’re opening up a new set of member benefits that include consultations and help overcoming these hurdles. Whether you’re lost or looking for a more cost-effective way to make it through DSME accreditation, or not sure how to navigate the waters of a CPA, we can help. Here’s what we’ve started:
Diabetic Educator Accreditation Consultation
Establishing a CPA–how to get started and find a partner physician
Hypertension RPM–what it entails, how to ensure you’re set up for it
These consultations are led by our Executive Clinical Director, Dr. Angelina Tucker Pharm. D., and one-on-one to ensure you’re getting the help that you’ll actually need.
Becoming an accredited diabetes educator is arduous, to put it lightly. Even with the best intentions, between staffing shortages and a stream of scripts to fill and inventory to keep up with, DSME accreditation can take months for pharmacists. It can also cost an arm, a leg, and the naming rights for your firstborn child. Dr. Tucker will provide guidance and assistance for Provider CSAO members in a thoughtful, cost-effective manner.
The CPA Prep consultation is designed to help pharmacies understand how a CPA can expand their practice. Frequently asked questions may include - How do I build these relationships? What can I bill for with a CPA? What legal documents do I need to legally establish the relationship? Although this may seem confusing, we have the answers! Not only can we put you in position to succeed with a CPA, but we’ll help with the documents required to make sure you are protected and getting paid for services. Remember, this is not something that you will be able to bill for directly, but you will be able to earn reimbursement through incident-to billing. (Don’t worry–that’s covered too. We’ve got you.)
Another option for pharmacists that is much needed in America is remote patient monitoring for hypertension. Pharmacists see their patients more often than any other healthcare professional, so it makes sense to have this crucial player in patient health to join in on the battle against hypertension–but it won’t do any good if the process of it gives you high blood pressure too. In this consultation we will discuss what’s needed to get this program off the ground in your pharmacy as well, no Lisinopril needed.
Whatever the clinical goals are for your practice, the very first CSAO will help you achieve them. We understand the difficulties of starting this side of pharmacy, and we understand that without both contracting and assistance navigating the setup of it all–well, you might hit a difficult roadblock that puts clinical services on the back burner, forever relegated to getting done “next quarter.”
We don’t want you to wait. Your patients don’t want you to wait. You don’t want to wait. Let us help you get it going and providing these invaluable services to your patients as soon as possible.
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