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Empowering Community Health and Revenue Growth: The Nuts and Bolts of Test and Treat

May 7, 2024

Thought leaders throughout the pharmacy industry continue to actively advocate for pharmacists to operate at the top of their licenses. One area of focus is expanding pharmacy care through test and treat programs.

The American Pharmacist Association (APhA) now offers a certification program to prepare pharmacy professionals to test and treat patients. We teamed up with Drug Store News to host a panel discussion on why expanding clinical services in pharmacies is necessary. And the Future of Pharmacy Care Coalition consistently encourages legislators to pass HR 1770/S. 2477 to codify the pharmacist’s ability to leverage Medicare coverage to include services related to test and treat.

Even with these efforts underway, it is essential to note that pharmacies can only pursue test and treat programs if they know how to get started.

Establishing Test and Treat in Your Pharmacy

Our blog post, Empowering Community Health and Revenue Growth: The Test and Treat Advantage for Pharmacies, provided the first three steps to consider when founding your test and treat programs. Here’s what you should focus on next:

1. Employ Powerful Clinical Documentation

Documentation can be complex because state, federal, and payor requirements vary.

  • A manual documentation process requires you to capture all the nuances by payor and state to receive full reimbursement.
  • Keep in mind that documentation is generally shared with state and federal agencies through the Electronic Lab Reporting (ELR) pathway.
  • A billing-enabled EHR can simplify this process and ensure you’re successfully capturing every detail to ensure proper documentation.

2. Understand Billing and Reimbursement

Billing and reimbursement are directly tied to documentation. Three parts of the lab billing process may be reimbursable:

  1. Lab Testing
    • All three major payor groups (Medicare, Medicaid, and commercial) approve reimbursement for the test if you are enrolled as a lab.
  2.  Sample Collection
    • Specimen collection billing is a solid pathway to commercial reimbursement if you are enrolled as a pharmacy without a CLIA waiver and you are sending the collection to a lab.
    • If there are commercial payors that you are not contracted with for this service, you may want to consider billing out-of-network until your enrollments are approved.
  3. Office Visit
    • Reimbursement for an office visit is tied to many processes, including medical necessity, documentation, and sometimes test results.

3. Drive Awareness

Once your Clinical Laboratory Improvement Amendment enrollment is complete, it’s time to get patients into the store.

  • Consider investing in technology to help engage your patients and promote your clinical and pharmacy services via multiple channels.
  • Some key action items to promote test and treat options include updating your website and mobile app, sending text messages to patients, and changing the inbound and outbound messages on your IVR.

Check Out Our Test-and-Treat Playbook to Learn More!

XiFin Pharmacy Solutions is committed to creating tools that support pharmacists and the communities they serve. Learn more about developing and implementing a test-and-treat program at your pharmacy by exploring our latest resource, A Playbook for Test and Treat.

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