Nutescu Edith A, Klotz Roger S
Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL 60612, USA.
Am J Health Syst Pharm. 2007 Jan 15;64(2):186-92. doi: 10.2146/ajhp060234.
A basic overview and definitions of commonly used billing and reimbursement terminology that pharmacists will need to know to obtain reimbursement for cognitive services are provided.
Currently, the profession of pharmacy has been gathering momentum in its efforts to seek and obtain reimbursement for cognitive services. However, there have been major barriers in seeking reimbursement, including the lack of understanding by third-party payers of the pharmacist's role in patient care and the pharmacist's in-depth knowledge of pharmacotherapy, the lack of appropriate billing codes for pharmacists' services, and the lack of detailed knowledge and understanding by pharmacy practitioners of nondistributive reimbursement mechanisms, processes, and terminology. The types of services provided are usually described by the American Medical Association's Current Procedural Terminology (CPT) codes for the face-to-face provision of patient care services by a pharmacist. As of January 1, 2006, pharmacists have been able to indicate the appropriate diagnosis code from the International Classification of Diseases, 9th Revision (ICD-9) (ICD-10 will replace the ICD-9 on October 1, 2007), and CPT code when billing under a major medical plan that recognizes the pharmacist as a patient care service provider. Understanding the billing and reimbursement terminology will aid pharmacist communication with third-party payers, Medicare, and Medicaid. A glossary of the most commonly encountered terms in billing and reimbursement procedures for cognitive services is provided. Also included are lists of Web-based reimbursement resources and references on reimbursement for cognitive services by the pharmacist.
An understanding of terminology is important in receiving reimbursement for cognitive services.
提供药师为获得认知服务报销所需了解的常用计费和报销术语的基本概述及定义。
目前，药学专业在寻求和获得认知服务报销方面的努力正不断发展。然而，在寻求报销过程中存在重大障碍，包括第三方支付方对药师在患者护理中的作用以及药师对药物治疗的深入知识缺乏了解，缺乏适用于药师服务的计费代码，以及药房从业者对非分配性报销机制、流程和术语缺乏详细了解。所提供服务的类型通常由美国医学协会的现行程序术语（CPT）代码描述，用于药师面对面提供患者护理服务。截至2006年1月1日，在将药师视为患者护理服务提供者的主要医疗计划下计费时，药师能够指明来自《国际疾病分类》第9版（ICD - 9）（2007年10月1日ICD - 10将取代ICD - 9）的适当诊断代码和CPT代码。了解计费和报销术语将有助于药师与第三方支付方、医疗保险和医疗补助进行沟通。提供了认知服务计费和报销程序中最常遇到术语的词汇表。还包括基于网络的报销资源列表以及药师认知服务报销的参考文献。
了解术语对于获得认知服务报销很重要。
