Understanding Health Care Billing Basics

Activity Preview

The current health care billing processes for patient care services in the United States is a complex system. It is a topic for many that is difficult to fully grasp, especially for pharmacists who are relatively new to the goal of generating revenue for patient care services. Learn about the basics of health care billing and the particular details and explanations of processes that are needed by pharmacists in order to pursue generating revenue for their services. 

Learning Objectives: 

At the completion of this activity, the participant will be able to:

1. List the four types of payers that reimburse for health care services.
2. State two strategies for potential revenue for pharmacist services from commercial payers.
3. Name the CMS documents that are the definitive source for the rules and regulations for health care reimbursement under Medicare Parts B, C, and D.
4. List the healthcare common procedural coding system (HCPCS) codes that may be used by eligible billing providers to generate revenue for pharmacist services.
5. List the "incident-to" rules for both institutional outpatient services and physician office services.

Activity type: Knowledge-based

Target Audience: Pharmacists 

Learning level: 1

Accreditation Information

The American Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.  This activity is approved for 2.0 contact hours of CPE credit (0.20 CEUs). The ACPE Universal Activity Number for this activity is 0202-0000-17-220-H04-P.

To obtain credit for "Understanding Health Care Billing Basics" complete the assessment with a grade of 70% or better, evaluation questions, and CLAIM credit. Participants will need to have a valid pharmacist.com username and password to claim credit. After your credit has been claimed, please visit CPE monitor for your transcript.

APhA continuing pharmacy education policy provides you with two opportunities to successfully complete this continuing pharmacy education assessment. Please note that the questions may not appear in the same order as printed and you will not be permitted to submit the assessment a third time. The current policy of the APhA Education Department is not to release the correct answers to any of our CPE tests. This policy is intended to maintain the integrity of the CPE activity and the assessment.

Initial release date: July 1, 2017
Expiration date: July 1, 2020 - NO CREDIT GRANTED AFTER THIS DATE


"Understanding Health Care Billing Basics” is a home-study continuing education activity for pharmacists developed by the American Pharmacists Association.


Mary Ann Kliethermes, BS, PharmD

Vice Chair and Professor

Chicago College of Pharmacy

Midwestern University

555 31 St Street

Downers Grove, IL 60515


Advisory Board

Anne Burns, BS, Pharm

Vice President, Professional Affairs

American Pharmacists Association

2215 Constitution Avenue, NW

Washington, DC 20037



Mary Ann Kliethermes, BS, PharmD declares that she is owner of Clinical Pharmacy Services, Inc.

Anne Burns, BSPharm and APhA's editorial staff declares no conflicts of interest or financial interests in any product or service mentioned in this activity, including grants, employment, gifts, stock holdings, and honoraria. For complete APhA staff disclosures, please see the Education and Accreditation Information section at www.pharmacist.com/apha-disclosures


There is no fee associated with this activity for members of the American Pharmacists Association. There is a $25 fee for nonmembers.

System Requirements

Computer and Internet access is required to complete this activity.  Please visit our website to view the Technology System Requirements to have a positive learning experience.

Credit Information

Activity Number Credit Amount Accreditation Period
ACPE# 0202-0000-17-220-H04-P 0.2 CEUs July 01, 2017 - July 01, 2020