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.

Key Features:

• 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.

Contents

1. History of Payment for Pharmacy Services
2. Understanding the Insurance Industry
3. Medicare, Medicaid, and Pharmacy Services
4. Disease Coding: ICD Codes
5. Procedural Coding: CPT and HCPCS Codes
6. Professional Pharmacy Services Codes
7. The HCFA-1500 Claim Form
8. Documentation
9. Generating New Revenue Streams for Institutions
10. Fraud and Abuse

Appendixes

• Glossary
• 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

Index

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