On November 21st, 2024, EnlivenHealth hosted a webinar that served as a comprehensive guide to Medicare’s PrEP coverage, medical billing, and reimbursements. The expert speakers for this session were Carter Tatum (Financial Solutions Strategy Manager at EnlivenHealth) and Angel Kahaly (Customer Enablement Consultant at EnlivenHealth).
The webinar mainly dealt with the important aspects of the PrEP (Pre-Exposure Prophylaxis) medication, its Medicare coverage, medical billing practices, the intricacies concerning 340B billing, the unique aspects of EnlivenHealth’s medical billing solution MedBill, and much more. As always, the webinar ended with a live Q&A session where Carter and Angel answered questions from our live audience.
Understanding Medicare’s PrEP Coverage
Carter opened the session with an introduction of EnlivenHealth’s mission and vision, highlighting the aim to revolutionize pharmacies by equipping them with digital tools to foster exceptional patient care, sustainable growth, and optimal population health. After the brief introduction, the two speakers dove right into the topic.
Angel led a discussion on the recent changes in Medicare coverage for PrEP medications. “As of September 30, 2024, Medicare covers these services without cost share,” she said. “This means no co-pays, no deductibles, no patient responsibility for these drugs.” Angel further explained the nuances of what services are covered under Medicare Part B and how to bill for PrEP medications at the pharmacy level.
Medical Billing for PrEP
The webinar delved into the practical aspects of medical billing for PrEP. Carter and Angel discussed the utilization of specific diagnosis codes and the importance of being in-network with Medicare and Medicare Advantage plans. Angel advised contracting with payers before billing, ensuring billability, and make sure to use the correct service date when billing Medicare. Carter then showed how EnlivenHealth simplifies the complexities of medical billing with MedBill. To illustrate, Angel walked viewers through the process and explained how claims submission would work. “The first claim is going to be your drug claim, and the second claim will be your dispensing fee claim,” she said, talking about submitting two separate claims for PrEP to optimize reimbursement.
A few webinar attendees asked questions during this segment, revolving around handling high copayments for PrEP drugs and contracting with Medicare Advantage plans.
Dealing with Billing & Reimbursement Challenges
A key takeaway from the session was how EnlivenHealth can assist with the challenging aspects of medical billing — ranging from the use of 340B modifiers and diagnosis codes for successful processing of claims to handling different patient cases that require the modifiers.
Angel mentioned EnlivenHealth’s commitment to providing support and guidance throughout the process to minimize the chances of claim denial, ensuring accurate submissions meeting all necessary requirements. However, she cautioned that, ultimately, it is up to the payer to determine whether a claim will be paid.
As for the reimbursement process, Angel informed the audience about MedBill’s capability to update the status of claims automatically, providing details on the billing timeline and discussing the potential risks and benefits.
Moving Ahead with EnlivenHealth
The webinar concluded with an announcement about an info session scheduled for the following week — an ideal opportunity for attendees to get a visual demonstration of the platform and its functionalities—especially surrounding PrEP. After that, Angel and Carter thanked the attendees and assured them that the medical billing team at EnlivenHealth is always available for questions and support. To watch the webinar in its entirely, click the button below!
To learn more about MedBill by EnlivenHealth, schedule a consultation with a member of our team today!