Module 10: Billing and Reimbursement
Course Description
This module will describe the general billing and reimbursement process including recognizing options and constraints in order to financially advocate for a patient and your organization.
The cost of care association with the treatment of cancer is incurred by both the patient and the organization treating the patient. Oncology treatments can cost over $10,000 to over $100,000 per dose, and carry a large financial burden to the health-system as a whole. Patients are often responsible for deductibles and copayments which can cost them thousands of dollars and can often leave patients bankrupt.
As oncology pharmacists, it is important to understand both the foundation and advanced aspects of billing, reimbursement, and financial support for the medication therapy we provide to our patients. Selection of regiments should be done based on both clinical and economic outcomes, and we have a duty to ensure that the patient will incur the least economic burden with the greatest clinical benefit. To that, we also need to ensure that the organization is reimbursed at a rate that ensures financial health of the business to ensure future patients can continue to receive treatment.
Learning Objectives
- Discuss fundamentals of inpatient and outpatient billing and reimbursement for medications
- Evaluate financial risk reduction strategies for oncology patients and health-systems
- Calculate reimbursement for Medicare Part B infusion scenario
- Examine current challenges with billing and reimbursement
This module includes an ACPE Pre- and Post-Test, an eLearning course, and a course evaluation. You must complete all of these module activities, in order, before claiming ACPE credits.
Presenter
Alexander Quesenberry, PharmD, BCOP, is the Baptist Memorial Health Care System Lead for Infusion Pharmacy Services, Director of Pharmacy for the Baptist Cancer Center, Baptist Specialty Pharmacy and Baptist Clinical Research Institute (BCRI) headquartered in Memphis, TN.
He completed his undergraduate and Doctor of Pharmacy degree in 2009 from the University of Mississippi. He began his career at Baptist with completion of a Post Graduate Year 1 (PGY1) Residency at Baptist Memorial Hospital - Memphis. He stayed on staff at Baptist Memphis, until joining the newly formed Baptist Cancer Center in 2012. He has been a Board Certified Oncology Pharmacist since 2014. Alex has been in a leadership role since 2015 and oversees the pharmacy operations within 18 clinics of the outpatient infusion centers, as well as oversight of the research pharmacy operations across the BMHCC system. Alex remains an active member in the national Hematology/Oncology Pharmacy Association (HOPA) and the local Tennessee Oncology Pharmacist Association (TOPA).
Alex previously served as Residency Director for the Baptist Cancer Center Post Graduate Year 2 residency. He founded the program in 2016. Since that time, the program has been successful in gaining and continuing accreditation by the American Society of Health-System Pharmacy. The program has matched with a resident in each of the past 9 years.
In addition to this teaching capacity, Alex also serves as clinical instructor for the University of Mississippi and assistant professor for the University of Tennessee. In 2021, Alex and his pharmacy team received the President's Quality Award Improvement from Baptist Memorial Health Care for their work on biosimilar implementation, and in 2022 Alex received the 40 Under 40 in Cancer award.
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Knowledge Course for Pharmacists
HOPA is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
To claim ACPE Credits the learner must complete all required activities, including the pre- and post-tests, and course evaluation. CE's will be reported within 1-2 weeks of completion of the credit claim activity.
Technology requirements: HOPA Learn requires a modern web browser (Internet Explorer 7+, Mozilla Firefox, Apple Safari, Google Chrome) and the ability to listen to audio with the content.