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Education for Medical Provider Billing
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Continuing Education for Medical Billing

Beginning on January 1, 2017, commercial health plans in Washington State will be required to include pharmacists as medical providers in their participating provider networks. Consequently, pharmacists can bill and be reimbursed for medical services if they are included in a health plan’s network and the services are covered in their contracts.

 

To become a network provider, Pharmacists will need to enroll by submitting an application. Each health plan has a process for enrolling in their network. For information about how to contact plans and enroll in their networks, check out our Contracting and Credentialing Resource Center (must be a WSPA member to view).


ProviderSource is an online system most of the health plans 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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