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Welcome to the WSPA Billing Resource Center - Get Started!

Billing for products and patient care services is a necessary competency. Sometimes it is more difficult than it should be. At WSPA, we recognize that being able to bill for the products and care that you provide is vital. We also recognize that time spent billing takes away from your patient care time. This resource is designed to provide tools and resources to expedite billing and address common questions or complex processes.

We have divided the Resource Center into several sections:

Provider Status Implementation Checklist for Health Systems Leadership
Contracting and Credentialing Resource Section (requires a WSPA membership to review)

Billing Patient Care Services Resource Section

Medical Provider Billing CE Course on WSPA’s Education Portal:

Since this bill requires health plans to include pharmacists in their medical provider networks, pharmacists must learn how to enroll in networks, including credentialing, contracting and privileging. Pharmacists and pharmacy technicians must also learn how to submit a medical insurance claim, including coding, billing and documentation. In order to support our members in implementation of this new law into their practices, WSPA has enlisted the credentialing, coding, and compliance support of knowledgeable professionals to develop trainings specific to pharmacy professionals.

To become a network provider, Pharmacists will need to submit an application. ProviderSource is an online system most of the health carriers use to collect credentialing information from providers. The "Credentialing as a Medical Provider Using ProviderSource" CE was developed in partnership with Teresa Davis, RV from ProviderSource to assist pharmacy professionals with this step. 

The WSPA developed this suite of Medical Billing CEs for the Pharmacy Professional as a comprehensive guide to prepare pharmacy professionals to document, code, and bill for medical services. The medical billing CEs include the following:

  • Medical Billing Module 1: Introduction to Medical Billing and Records presents medical billing and coding systems to familiarize pharmacy professionals on the new processes they must use to bill for medical services;
  • Medical Billing Module 2: Incident to and General, Direct, and Personal Supervision delineates how to utilize the ‘incident to’ rule in pharmacy practice;
  • Medical Billing Module 3: Introduction to Evaluation & Management Codes focuses on the use of these codes in pharmacy practice.
  • Medical Billing Module 4: Navigating the Medical Revenue Cycle connects the medical billing process with managing revenue cycle;
  • Medical Billing Module 5: Time Based Evaluation and Management discusses the appropriate use of time-based method in coding and billing;
  • Medical Billing Modules 6: Key Components of History in the complexity-based method of coding and billing.
  • Medical Billing Modules 7: Key Components of Examination in the complexity-based method of coding and billing.
  • Medical Billing Modules 8: Key Components of Medical Decision Making in the complexity-based method of coding and billing.
  • Medical Billing Module 9: Auditing Medical Record utilizes WSPA’s auditing tool to ensure appropriate coding and mitigate audit risks.
  • Medical Billing Module 10: Compliance Laws and Regulations focuses on complying with laws and regulations for medical billing and coding purposes.

Each of the CEs in the suite build upon the content of the preceding courses. Therefore, WSPA recommends learners begin from Module 1 of the Medical Billing CEs, and complete each course in order. In addition, these CEs include pharmacy specific case studies to highlight the role of pharmacy professionals as medical providers as well as illustrate the connection between documentation and appropriately coding and billing for these services. For a complete description and pricing click here.

The Medical Billing CEs are ACPE accredited for pharmacists and technicians, and are available in the WSPA Education Portal. Please make sure to sign in to the WSPA website to aid your login process to the portal and follow the instructions on the WSPA Education Portal page.  WSPA members receive a 40% discount on these CEs. The discount code is available here.

If you are interested in joining the WSPA and receiving discounts that membership provides, please become a WSPA member here.

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