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Getting Reimbursed For Clinical Services: 4 Things You Need To Know

Rules and regulations affect every industry, and pharmacy is no exception. As the role of pharmacists continues to evolve and expand, so do the requirements that allow them to act as essential, frontline caregivers in an ever-changing healthcare landscape.

The ability to perform clinical services is managed at the state, and occasionally the national, level. And we’ve seen incredible progress in that area, especially in the past 18 months. For example, pharmacists in a number of states have the ability to prevent, test and treat illness like flu, strep and soon COVID-19. Pharmacists in any state can now administer vaccines to kids over the age of three. Pharmacists in 19 states and counting can prescribe hormonal contraceptives. And the list goes on and on.

But getting paid for performing these services is a different animal. In the case of reimbursement, payers treat you like any other provider. And with that comes payer-driven standards for providing services, generally called credentialing. Once credentialing standards are met, pharmacists also have to be contracted as a provider with each payer they want to bill. 

As provider status expands and pharmacist-administered clinical services become more prevalent, understanding how to manage pharmacist credentialing and contracting is critical to a profitable clinical services strategy. Read more >

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