Wiki Careers in pharmacy for Medicare, etc. prescription claims; do they exist?

[Scandaboo]

I'm wondering if anyone has any sort of insight on whether there are any sort of positions that exist in billing coding, but for pharmacies, especially for Medicare B. I've been working in various pharmacies for years and I'm currently working on my CPC coursework, which i will then go onto billing. I work in long term care pharmacy and we are not contracted with Med B, so patients have to get their diabetic supplies and other supplies at retail pharmacies, or pay cash from us.

Wouldn't you think a coder would be very useful for this kind of situation, so that we could get reimbursed from Med B? I heard one of the reasons why we aren't contracted is because we need the Dx codes for everything, and they simply don't have the manpower to harass doctors for codes. Thoughts?

 

[thomas7331]

The CPC certification, as the acronym indicates, is geared toward professional coding - mainly the services performed by physician and NPP providers. Pharmacies do not fall into this category and generally do not bill services to Medicare Part B. Prescription drug claims are billed to Part D - I'm not sure that a pharmacy can even enroll with Medicare as a Part B provider. (The exception might be for medical supplies and equipment which can be billed to Part B if the pharmacy is credentialed as a DMEPOS provider - there is some coding knowledge required for that field but it a rather small and limited subset of the field of coding in general.)

If you're looking to get into the field of pharmacy reimbursement, the CPC route isn't really going to be much help as the education and training associated with this certification rarely, if ever, gets into prescription drug claims outside the context of coding for the medications administered within a facility or physician office, and I'm not aware that pharmacies employ coders for their billing process. I imagine there would be little use for the CPC skill in most pharmacy billing because coding involves translation of physician documentation into codes - pharmacies do not generally employ physicians or maintain medical records for the patients to whom they supply prescriptions.

 

[SharonCollachi]

Wouldn't you think a coder would be very useful for this kind of situation, so that we could get reimbursed from Med B? I heard one of the reasons why we aren't contracted is because we need the Dx codes for everything, and they simply don't have the manpower to harass doctors for codes. Thoughts?

You wouldn't be able to choose a dx code anyway, the doctor has to provide it.