Involvement of a state society of hospital pharmacists in third-party reimbursement for nondistributive services.

The investigation by a state society of hospital pharmacists of the possibilities for third-party reimbursement for nondistributive services is described. A questionnaire was sent to all hospitals in the state to determine what nondistributive services were being performed that might qualify for third-party reimbursement. A committee was established to investigate what nondistributive services were being reimbursed separately and which nondistributive services had reimbursement potential, and to establish guidelines that hospitals might use in seeking reimbursement for these services. Of 150 hospitals in the state, 71 returned the questionnaire and 44 (62%) of those hospitals indicated that they offered at least one nondistributive service, but only two reported that they were receiving reimbursement. The committee found that there are two reimbursement mechanisms available to cover cost of nondistributive services: (1) direct billing of the third parties for the individual service, or (2) inclusion of the cost of the service with patient charges for drugs. After meeting with Blue Cross & Blue Shield, the major third-party payer in its state, the committee determined that BC & BS would reimburse the institution for the costs incurred in patient-care services plus an additional 13% overhead fee. In general, the cost of providing the nondistributive service should be reflected in the cost of the pharmacy operating budget, and reimbursement is made to the hospital rather than to the direct provider of the service. A statewide effort can help establish reimbursement procedures for nondistributive services and prevent duplication of efforts by individual institutions investigating reimbursement.