(1285) Implementation of Medical Billing by Pharmacists: A Necessary Step for Sustainable Practice Models

Objectives: The objectives of this innovative practice effort are to: 1) develop and provide resources to aid in the implementation of medical billing for pharmacist services and 2) increase implementation of protocol-driven care at various practice sites. In December of 2017, Kentucky pharmacists were granted the authority to provide care utilizing population specific collaborative practice agreements known as Board Authorized Protocols. Since then, this authority has expanded to include 18 authorized conditions and 20 unique protocols. With 98 of Kentucky’s 120 counties designated as medically underserved areas (MUAs) by the Health Resources and Services Administration, protocol-driven care regulation was enacted to help expand access to care. Despite the measures taken, however, widespread implementation of protocol-driven care has yet to be achieved. As our team has previously reported only 16% of outpatient pharmacies in the state have an executed protocol. Furthermore, only 48% of Kentucky counties designated as MUAs have a pharmacy reporting an executed protocol. One of the primary reasons reported for low uptake of protocols has been lack of payment for services, hindering the development of sustainable practice models. Our continued work in this area indicates that payment continues to be a barrier despite recent legislative changes mandating commercial insurances pay for pharmacist services.

Methods: Efforts began with a needs assessment and development of a transformation network through workgroups from 6 stakeholders across Kentucky. Awareness of legislative changes and their impact on practice was raised through presentations at association meetings and introductory guides. Continued work with payors and state associations culminated in the development and delivery of a medical billing workshop to 70 pharmacists from Kentucky and 13 other states. The development of an Advanced Pharmacy Practice Toolkit to assist with implementing and billing advanced clinical services is ongoing. Once completed, the toolkit will be disseminated amongst our established network and available to any interested parties. Each person who obtains a copy of the toolkit will be asked to provide feedback through a standardized survey to measure user satisfaction, desire to implement, and other facilitators and barriers of implementation.

Results: Preliminary findings: Successful engagement with stakeholder members indicates that awareness of recent legislative changes and the ability to bill for services has increased. With the dissemination of the toolkit and resultant surveys we anticipate an increased readiness to implement medical billing.

Conclusions: N/A