SPs can help to close that gap of patient care processes. SPs will support patients by educating patients …show more content…
SPs will collaborate closely with providers’ office to obtain patients’ medical information including diagnoses, ICD-9, ICD-10, CPT codes, histories and physical, progress notes, assessment plans, lab results, and so on; then, SPs will communicate with insurances to initiate prior authorizations, appeals in case of denials for specialty medications. Once medications are approved by insurances, SPs will help patients to start the necessary treatments in timely manners by assisting them to relieve the high copayments, proactive counseling and educating patients, and promoting patients’ adherence to treatment through their courses of …show more content…
Therefore, knowledge of insurances for pharmacy and medical benefits are essential. For examples, chemotherapy or transplant medications dispensed from SPs are eligible for reimbursement from Medicare part B only when patients are not admitted to skilled nursing facilities (SNF). HIM professionals must screen patients’ statuses before allowing medications to be sent out to prevent non-reimbursement