title: Billing for pharmacists' cognitive services in physicians' offices: multiple methods of reimbursement.
abstract: OBJECTIVE
  To evaluate the charges and reimbursement for pharmacist services using multiple methods of billing and determine the number of patients that must be managed by a pharmacist to cover the cost of salary and fringe benefits.
  
  
  METHODS
  Large teaching ambulatory clinic in North Carolina.
  
  
  METHODS
  Annual charges and reimbursement, patient no-show rate, clinic capacity, number of patients seen monthly and annually, and number of patients that must be seen to pay for a pharmacist's salary and benefits.
  
  
  RESULTS
  A total of 6,930 patient encounters were documented during the study period. Four different clinics were managed by the pharmacists, including anticoagulation, pharmacotherapy, osteoporosis, and wellness clinics. "Incident to" level 1 billing was used for the anticoagulation and pharmacotherapy clinics, whereas level 4 codes were used for the osteoporosis clinic. The wellness clinic utilized a negotiated fee-for-service model. Mean annual charges were $65,022, and the mean reimbursement rate was 47%. The mean charge and collection per encounter were $41 and $19, respectively. Eleven encounters per day were necessary to generate enough charges to pay for the cost of the pharmacist. Considering actual reimbursement rates, the number of patient encounters necessary increased to 24 per day. "What if" sensitivity analysis indicated that billing at the level of service provided instead of level 1 decreased the number of patients needed to be seen daily. Billing a level 4 visit necessitated that five patients would need to be seen daily to generate adequate charges. Taking into account the 47% reimbursement rate, 10 level 4 encounters per day were necessary to generate appropriate reimbursement to pay for the pharmacist.
  
  
  CONCLUSIONS
  Unique opportunities for pharmacists to provide direct patient care in the ambulatory setting continue to develop. Use of a combination of billing methods resulted in sustainable reimbursement. The ability to bill at the level of service provided instead of a level 1 visit would decrease the number of patients needed to pay for a pharmacist.
authors.affiliation: Eshelman School of Pharmacy, University of North Carolina, One University Heights, 121 Karpen Hall, CPO 2125, Asheville, NC 28804, USA. mollie_scott@unc.edu
authors.forename: Mollie Ashe
authors.initials: MA
authors.lastname: Scott
authors.forename: William J
authors.initials: WJ
authors.lastname: Hitch
authors.forename: Courtenay Gilmore
authors.initials: CG
authors.lastname: Wilson
authors.forename: Amy M
authors.initials: AM
authors.lastname: Lugo
mesh_terms: D018588:Fee-for-Service Plans / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D009657:North Carolina; D010593:Pharmaceutical Services / Q000191:economics*; D010595:Pharmacists; D010824:Physicians' Offices; D024382:Professional Role; D012051:Reimbursement Mechanisms; D012189:Retrospective Studies