Medical Billing Strategies for Point-of-Care Testing in Community Pharmacy

Opinion
Video

A panelist discusses how medical billing for point-of-care testing represents a significant revenue opportunity for pharmacies. Further, though the process will be initially unfamiliar, pharmacists should learn and control it rather than outsourcing it.

Reimbursement and Revenue Generation

Main Discussion Topics:

  • Medical billing processes for pharmacy clinical services
  • Current Procedural Terminology (CPT)and International Classification of Diseases (ICD) coding fundamentals for pharmacy
  • Revenue potential from point-of-care testing

Key Points for Physicians:

  • Pharmacies bill using the same CPT/ICD coding system as medical practices
  • Four primary goals of point-of-care testing: disease identification, disease monitoring, behavior modification, and reducing barriers to care
  • Pharmacy-based testing improves access for patients without primary care providers

Notable Insights:

  • Medical billing follows batch processing rather than real-time adjudication
  • Developing internal billing expertise prevents revenue loss to third-party vendors
  • Patients who use point-of-care testing are frequently aged 18 to 44 years, with approximately one-third lacking a primary care provider

Clinical Significance:

Mastering medical billing processes represents a critical competency for pharmacy’s evolution beyond prescription dispensing, creating sustainable revenue streams through clinical services that address significant health care access gaps.

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