It is no news that pharmacists are able to bill incident to a physician when providing patient care services. This has been widely discussed since the American Academy of Family Physicians (AAFP) requested clarification on this from CMS back in 2014. Despite this clarification, some pharmacists have still faced pushback on billing incident to the physician and there have been additional restrictions placed on the types of codes and level of service that pharmacists can bill incident to.
An additional gap in pharmacists’ ability to bill incident to has been through the provision of telehealth services. However, with the pandemic we have seen an explosion in demand of telehealth services and quick rule changes allowing for non-physician practitioners (NPP) to bill incident to the physician through telehealth services. We saw Medicare provide further clarification around this during the pandemic detailing out that pharmacists can bill incident to for their telehealth services as well. While encouraging, these rule changes all had the provision that they would continue in effect through the public health emergency (PHE). Many pharmacists have been understandably concerned that once the PHE is lifted, they will no longer be able to bill for telehealth services, and patients will consequently lose access to care they have come to expect.
On August 3rd, President Trump signed an Executive Order (EO) that requests the Secretary of HHS to evaluate within 60 days the additional telehealth services offered for Medicare beneficiaries during the PHE, and propose a regulation to extend these measures beyond the PHE. In response to the EO, CMS specifically mentioned pharmacists being able to bill incident to a physician or other NPP as a service that it would recommend for continuation after the PHE. This is encouraging as we hope this means pharmacists will be able to continue to bill incident to for the telehealth services they are providing. CMS included similar language in its Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021 as well, providing further confidence of the center’s prioritization of this in future plans.
Although encouraging, we have discussed the need by our patients for pharmacists to directly bill for our services through recognition as healthcare providers under Medicare Part B. Billing incident to the physician and NPP with further expansion to the telehealth space is a step in the right direction, but still far off from where we need to be. There remains an opportunity to advocate for provider status language in the next COVID-19 legislative package. Check out our post here where we discuss ways you can take a few minutes to make a positive impact for patient access to care.
More will come soon as the Secretary of HHS releases their plan in the coming two months and we will likely see more health and pharmacy policy changes that will impact the practice of pharmacy.