Reimbursement for Cognitive Services: The Community Pharmacist's Role

Abstract

Pharmacists of the 1990s must anticipate a continued decline in their distributive role and a continuing expansion in their nondistributive role. The Pharmaceutical Care model will lead to the further development and expansion of nondistributive services that are knowledge-based. Cognitive Services, the pharmacy service model center to the Pharmaceutical Care model, will become more important to the practice. Now that many pharmacists have implemented Cognitive Services and are receiving reimbursement for these services, we will see continued growth. Many of our colleagues are receiving reimbursement for Cognitive Services on a regular basis both from the payors and the patient. The mechanisms (ie, written documentation, patient clearance, claim generation) are now presently documented and used in community pharmacy practice. The HCFA form 1500 is a standard form for submitting claims. The documentation and mechanisms required to achieve reimbursement for Cognitive Services are discussed in this article. Proper documentation of the need for care and the services (interventions) provided by the pharmacist are essential to achieving full reimbursement.