Pharmacy resident third party credentialing and reimbursement in a family medicine clinic

Introduction While numerous studies have proven the impact of pharmacists on clinical outcomes, there is a paucity of data demonstrating successful reimbursement of pharmacist services by commercial and other payors. Furthermore, the level of reimbursement necessary to sustain a pharmacist resident position has not been evaluated and has potential to be a more achievable goal given the lower direct costs of a resident position. Objectives The objective of this study was to qualitatively describe reimbursement and credentialing of a Post Graduate Year Two (PGY2) Ambulatory Care Pharmacy Resident in a newly established part-time resident clinic. Methods This was a prospective quality improvement study evaluating credentialing progress and reimbursement data in a resident-run Family Medicine clinic from 1 July 2020 to 25 June 2021. Patients underwent evaluation and management of chronic diseases by the PGY2 under a collaborative practice agreement. The primary outcome studied was total reimbursement received from resident-provided pharmacy services. Secondary outcomes included percentage of charges reimbursed, number of billed encounters completed, and the number and type of third party payors with whom the resident was credentialed. Results During the study period, the PGY2 was credentialed with 11 third party payors and completed 232 billable encounters. $24 558 was billed during the study, comprising $18 533 and $6025 from evaluation and management and medication therapy management codes, respectively. Total reimbursement received for the resident's services was $13 765, approximately 56% of billed charges and 18.4% of the resident pharmacist's annual salary and benefits. This was primarily collected during the last 3 months of the study period. Conclusions The PGY2 was able to successfully become credentialed with various third party payors and receive reimbursement for covered services. This could provide a potential opportunity to fund some, if not all of a PGY2's salary and benefits.