by Michael D. Hogue
The Pharmacist's Guide to Compensation for Patient-Care Services offers practical information on dealing with insurers, gaining recognition as a provider of services, using diseases and procedure codes, and completing claim forms.
- 12 chapters, starting with a history of payment for pharmacy services, moving to step-by-step advice on using claim forms, and ending with troubleshooting tips for rejected claims.
- Case-based exercises in completing claim forms.
- A detailed chapter on documentation—legal aspects, its value as a communication tool, and its importance for compensation. The use of SOAP notes and electronic documentation systems are discussed.
- A chapter on promoting the value of pharmacy patient-care services to creat new revenue for hospitals.
- 11 appendixes, including sample forms, Medicare and Medicaid contacts, documentation guidelines, and a glossary.
- History of Payment for Pharmacy Services
- Understanding the Insurance Industry
- Medicare, Medicaid, and Pharmacy Services
- Disease Coding: ICD Codes
- Procedural Coding: CPT and HCPCS Codes
- Professional Pharmacy Services Codes
- The HCFA-1500 Claim Form
- Generating New Revenue Streams for Institutions
- Fraud and Abuse
- Evidence of the Value of the Pharmacist
- HCFA-1500 Health Insurance Claim Form
- Medicare Provider/Supplier Enrollment Applications
- Medicare Part A Intermediaries and Part B Carriers
- State Medicaid Directors
- Contact and Ordering Information
- Pharmacist Care Claim Form
- HCFA-1450 (UB-92) Claim Form
- Medicare 1997 Documentation Guidelines for Evaluation and Management Services
- Sample Medical Necessity Forms