Pharmacists practice in a variety of settings - from independent and chain community pharmacies to clinics and private medical practices. Some are consulting pharmacists who do not dispense drugs in pharmacies but instead provide MTM services full-time from their homes or from libraries, churches, coffee shops, or offices. It is a known fact that MTM services began in 2003 following the passage of the Medicare Modernization Act, and in 2006 MTM services were provided to Medicare Part D beneficiaries.
Further to this, the Affordable Care Act, passed in 2010, addressed pharmacist provision of patient care services, including MTM, as the US government soon realized the increase in drug-related problems and deaths which costs the economy billions of dollars, including other issues such as the increased complexity of care with patients who often end up seeing multiple providers and the single most worrying factor – the declining health literacy.
There is no doubt that the health care system needs MTM every day, every-hour basis, especially given that 40% of the U.S. population receives prescriptions for four or more medications and nearly over 300,000 over-the-counter medications are issued out, with nearly 40% of Americans trying alternative medicines.
So the onus rests on the pharmacists to help enhance patient care and reduce the high cost of drug-related morbidity and mortality in the U.S. So how can pharmacists gear towards MTM help in increasing their revenues too along with reducing costs and improving healthcare?
Pharmacists should bill for MTM services when providing for medication counseling, provided there is MTM service available in their area of practice. MTM services may be billed via universal claim form (HCFA-1500) using MTM CPT Codes. Universal claim forms are available online. These codes are essential for any pharmacists conducting MTM services: 99605 - MTM service(s) provided by a pharmacist to an individual patient during a face-to-face encounter that involves an assessment on intervention if provided; used to code the initial 15 minutes with a new MTM patient.
99606 - Initial 15 minutes with an established patient
99607 - Each additional 15 minutes of an initial or subsequent MTM encounter
The use of technology for automatic refills is an easy way for pharmacies to help with monthly compliance routine counseling sessions making them more efficient.
By identifying new targeted intervention programs and assisting in the comprehensive medication review preparation by compiling lists of medications that patients are taking, the one on one interaction will definitely boost the pharmacists' role in the community and lead to greater footfalls.
Having shorter MTM sessions rather than longer ones is seen as a much easier way both pharmacists and patients towards a more effective and efficient session.
Pharmacists must train their staff, including interns and technicians, to help enhance MTM services. This may involve making phone calls, scheduling appointments, and making other preparations that do not involve clinical expertise. This may require a bit of reorganization of staff and infrastructure – jotting notes in the computer system that serve as reminders during pickup providing the pharmacist a chance to provide MTM services or follow-up at that time.
Being more organized helps patients realize efficiency: By creating a system to manage medication reviews and claims in progress, documenting the calls to the patient, and prioritizing and following up checks for new claims online helps make MTM a part of the daily pharmacy routine.
Sharing of new drug information & therapies that can impact the treatment plan helps define a pharmacist's role in the healthcare system towards patients.
Appropriate billing and coding: if outsourced, this can help pharmacist and staff to focus more on the patients, their sessions and follow-ups and also receive feedback on the rules and regulations and updated Medicare Fee Schedule from the experts who know when the changes have come in and how they can be integrated into the system to help pharmacists to expand their core focus.
It serves not only to increase pharmacists' role as health care providers but also helps pharmacists improve their revenues in today's collaborative and Value Fee-based system. The field of pharmacy is no longer just the dispensing of medication over the counter (OTC) but providing healthcare service to their patients with follow-ups can be a taxing experience, which requires time and effort.
So outsourcing the administrative part of the work, and then concentrating on their expanding service will only help improve your Revenue Cycle Management process and also give pharmacists more time to invest in helping bring patients compliance to their own healthcare.
Published By - Medical Billers and Coders
Published Date - Jun-20-2016