Workflow Services by ImageMover

Workflow Services Product Update and Newsletter Vol. 4 February 19, 2025

Shannon and Gretchen with Lucas Smith of Salida Pharmacy and Fountain in Salida, CO.

Workflow Services is committed to meeting the needs of our customers. We listen carefully to feedback you share and make updates as quickly as we are able. This newsletter will help you stay informed of new features in our platform and keep you updated on industry news. 

In this issue you will learn more about the following:

• Colorectal Cancer Awareness Month
• Contracting and Credentialling 
  • The Importance of Advocating for Change
• Education
  • Accuracy matters with medical billing
• Medical Billing
  • Type 2 NPI update
  • Getting Paid More for Vaccines
• Additional Resources

MAKING A DIFFERENCE

March is Colorectal Cancer Awareness Month!

Pharmacists play a vital role in helping patients take charge of their health, and the CRC screening program from Workflow Services and Exact Sciences (the makers of CologuardⓇ) is a perfect example of this impact. Launched as a pilot in March 2024, this program started with 50 pharmacies. Now, with over 200 participating pharmacies, this program continues to help enrolled pharmacies promote colon cancer screening, a crucial step in early detection.

By leveraging their trusted relationships with patients, pharmacists can provide not only crucial education around the importance of timely screening, but also access to Cologuard (a noninvasive, effective and affordable at-home colon cancer screening test that requires no prep) for eligible patients. Even more important is that over 20% of the patients supported through this program to date do not have a relationship with a PCP, which means they may not have had access to this education and screening through other means. This program is leading to potentially life saving information for many patients.

Whether participating in the Workflow Services CRC Program or not, pharmacies can use March—Colorectal Cancer Awareness Month—as an opportunity to start conversations and help more patients get screened. Every conversation makes a difference in saving lives!

CONTRACTING AND CREDENTIALLING

The Importance of Advocating for Change

Legislation continues to evolve state by state as it relates to performing and being reimbursed for clinical services in pharmacies, however just because the laws change, it doesn't mean all stakeholders in the ecosystem jump to comply. 

For example, in Colorado, HB21-1275 paved the way for reimbursement of medically necessary services provided by pharmacists that are within their lawful scope of practice, are otherwise covered under Medicaid when provided by other medical providers and are not duplicative of pharmacist services already reimbursed under the medical assistance program. Similarly, HB18-1112 established a mandate for coverage of pharmacist services under health benefit plans if the services are otherwise performed by a licensed physician or advanced practice nurse and the services are provided in a health professional shortage area. 

Despite this, when one of our Colorado customers reached out to the top commercial payor in their area to apply for a contract, they were denied. After multiple attempts, our pharmacy partner took matters into their own hands and contacted the state board of pharmacy to file a complaint and request support. 

By partnering with the state board, they were able to put additional pressure on that payor to comply with the law and provide them with a commercial contract. This made an immediate impact on the pharmacies revenue stream, and that will continue to grow over time as their community becomes more aware of the high level of care they can receive in pharmacies beyond filling prescriptions and receiving vaccinations. 

You can read more about this revenue unlock in our recently published white paper: How Medical Billing Is Unlocking Healthcare’s Most Underutilized Asset: The Community Pharmacist — Workflow Services.

If you find yourself in a similar situation, where you are being denied a contract or other terms that should be granted to you based on the legislation in your state, we highly recommend working with your state board of pharmacy or other similar organizations for support. 

We also offer contracting and credentialing services and would be happy to help you push for contracts that may be available to you in your state. 

EDUCATION 

Accuracy Matters with Medical Billing

Medical billing has opened a whole new world of opportunities for pharmacies. And while it’s exciting to see all the codes that pharmacists can use to get paid for clinical services , medical billing  requires accuracy and a clear understanding of the rules. Billing mistakes can lead to denied claims, audits, and even financial penalties. Here are some important things to keep in mind.

Medical Necessity Matters

The American Medical Association (AMA) defines medical necessity as healthcare services that are reasonable, necessary, and appropriate based on clinical standards. Insurance companies and Medicare/Medicaid will only reimburse services that meet these criteria. 

An example of something that would not be considered medically necessary in a pharmacy and should not be billed for is a routine blood pressure check for a patient without any symptoms, diagnosis, or physician referral.

When billing, always document why the service was necessary for the patient’s health and treatment plan.

Be Accurate in Reporting

Using the correct billing codes helps to ensure payment and avoid errors. Incorrect coding can lead to claim denials, repayment demands, or penalties. Workflow Services make this easy for you. Our team has done the research to learn what codes apply to a given service and have those built in for you when using our workflows to document the services you provide.

Coming soon! We will be launching a template builder that allows you to choose your own codes for services you provide beyond those we support today. Understanding how to choose the right code/s will be important for quick turnaround time on claims. 

Understanding Time-Based Codes

Some services use time-based CPT codes, which means the time spent with a patient determines the billing code. The AMA provides guidance on calculating time, which includes both face-to-face time with the patient and certain non-face-to-face activities on the same day, such as reviewing records and coordinating care. Be sure to document the total time spent accurately.

Our most commonly billed service, preventative counseling, requires an accurate report of the time a pharmacist spends face-to-face counseling a patient while delivering care. This does not include time spent preparing medication/vaccines or checking a vaccine registry. 

Additionally, when billing for time-based services, pharmacists should only include the time spent delivering medical information or providing a healthcare service—not general conversation. While building rapport with patients is important, time spent discussing personal topics like their grandkids or vacation plans is not billable. The recorded time should be reasonable for the service provided, ensuring accuracy and compliance with billing guidelines.

Beware of Audits

Insurance companies and Medicare/Medicaid conduct audits to verify the accuracy of claims. If errors or inconsistencies are found, providers may have to repay money, face fines, or even be excluded from billing certain payers. For services performed in our platform, we keep detailed, clear records helps protect against audit issues.

Final Thoughts

When it comes to medical billing, pharmacists must prioritize accuracy and compliance over shortcuts or questionable practices. Just because other pharmacies may be getting away with improper billing doesn’t mean it’s the right approach—or that it will go unnoticed forever. Working with a software partner like Workflow Services who conducts thorough research, follows official guidelines from sources like CMS and the AMA, and ensures claims are properly documented helps protect you and your pharmacy against audits, fines, and potential legal consequences. In the long run, doing things the right way builds trust, ensures proper reimbursement, and safeguards your reputation.

MEDICAL BILLING 

Get Paid More for Vaccines

In states where pharmacists have provider status with Medicaid and billing for vaccines is allowed, we encourage pharmacists to submit claims through Workflow Services when administering vaccines. 

Our customers are getting reimbursed more for the vaccine and admin and earning additional revenue from the counseling they are providing patients while administering vaccines. 

In Colorado we are seeing vaccines billed through the medical benefit getting reimbursed an average of 13.71% higher, with increases up to 23.55%. In addition to higher reimbursements, these claims are not subject to DIR fees, providing pharmacies with more stable and predictable revenue.

Type 2 NPI Update

The Workflow Services team is constantly learning and refining the process of setting up pharmacies for medical billing. We have previously provided guidance on obtaining a Type 2 NPI dedicated to medical billing, and we now have new information to share. 

• We recommend using the following taxonomy codes with the new NPI:
  • 261QP2300X (Clinic/Center Primary Care)
  • 261QH0100X (Clinic/Health Center - Health Services)
  • 207Q00000X (Family Medicine)
• Once you have your new NPI set up, obtain a new Medicaid enrollment set up as a 'Physician Group' for you and your pharmacists.
• Confirm that your new Medicaid ID's taxonomy code matches the primary taxonomy code associated with your new Type 2 NPI. 
• Associate all providers at your location with this new Medicaid ID. 
• If you have multiple pharmacy locations, a single Type 2 NPI can be used, however all locations must have the same tax ID (TIN).

ADDITIONAL RESOURCES

Let's Talk! Come to our Office Hours

Drop-in to our weekly “Office Hours” to chat with a member of our team. These meetings have no set program, but we will be there live on a video call to help. Here are just a few reasons you might want to join:

• Get a quick question answered, live and in-person
• Discuss strategies for getting the most out of Workflow Services
• Walk through a Workflow that you don’t currently use, but are considering

Follow this link to see all available times and register for an upcoming session.

Thank you for staying up-to-date with the latest Workflow Services enhancements. We're excited to keep enhancing our offering to meet your needs and streamline your workflow. As always, don’t hesitate to reach out via the email below with questions or drop by our office hours for personalized assistance.

Workflow Services by ImageMover
support@imagemovermd.com