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PRIMARY UNDERSTANDING OF MEDICAL BILLING AND PATIENT CARE SERVICES

Author: Korlapu Pallavi

Introduction:

To provide pharmacists a basic understanding of healthcare billing and current opportunities for generating revenue for their patient care services.

BASIC KNOWLEDGE ON BILLING:

• The current U.S health care billing process for patient care services is a complex and difficult system for many to fully grasp, especially pharmacists who are relatively new to generating revenue for patient care services.
• Community pharmacists across the United States have had their scope of practice expanding for the delivery of patient care services beyond the clinical care involved through medication dispensing, including authorities to prescribe medications and order tests.
• Billing for services is a critical function for maintaining the financial viability of healthcare institutions. Poor understanding of the system can lead to incorrect documentation, which can result in a claim rejection.
• The literature suggests that the education needs of medical practitioners in relation to medical billing compliance are not being met and medical practitioners desire more education on this topic.
• There is broad agreement among medical education stakeholders in multiple jurisdictions that medical billing should be viewed as a core competency of medical education, though there is an apparent inertia to include this competency in medical education curricula.
• Penalties for non-compliant medical billing are serious and medical practitioners are at risk of random audits and investigations for breaches of sometimes incomprehensible, and highly interpretive regulations they may never have been taught.
• And also, high medical prices and billing practices may reduce public trust in the medical profession and can result in the avoidance of care.
• This article provides the basics of healthcare billing and explains the particular details and processes. Pharmacists need to know to generate revenue for their services.

Conclusion:

Although pharmacists have yet to universally establish themselves as health care providers able to bill payers in federal and state programs, they have the opportunity to work as auxiliary personnel under an eligible provider who may bill for a pharmacist’s services. This, pharmacists, are capable of generating revenue. The process remains complex and requires a clear understanding of the rules and regulations.

Despite the acknowledged significance of waste in health systems due to poor practitioners knowledge of billing practices, there has been very little research to date on education interventions to improve health system efficiency at a practitioner level.

Reference:

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https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-021-00631-x

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