Current Outcomes® MTM Opportunities in Washington Pharmacists enrolled in the Personal Pharmacist network may provide and bill for Medication Therapy Management (MTM) services with Outcomes. To participate, pharmacists must complete the Personal Pharmacist Training Program and work at a pharmacy or other type of business (i.e. clinic, consultant setting, etc.) that has executed an Outcomes MTM Network Participation Agreement. Below is a listing of current MTM opportunities. Please note that covered services and fee schedules may vary by program.
Humana Outcomes® MTM Program Overview: Outcomes assists community pharmacists in providing Medication Therapy Management (MTM) services for employees and health plan members. Outcomes Pharmaceutical Health Care® (Outcomes®) is administering the MTM program.
Launch Date: Early November 2009
Location: Washington (Region 23)
Eligible Members: All pharmacists enrolled in the Personal Pharmacist network may provide and bill for medication Therapy Management (MTM) services with Outcomes. To participate, pharmacists must complete the Personal Pharmacist training program (available at www.getoutcomes.com) and work at a pharmacy or other type of business that has executed an Outcomes MTM Network Participation Agreement.
Covered Services: • Comprehensive Medication Reviews (CMR) $50.00
• Prescriber Consultations $20.00
• Patient Compliance Consultations $20.00
• Patient Education & Monitoring $10.00 Each member is eligible for one Comprehensive Medication Review annually and as many other covered services as is necessary and appropriate. Please see the Outcomes Personal Pharmacist™ training program and the Outcomes MTM Policy and Procedure Guide for further details.
What do you need to do to start billing?
Pharmacy Contracting: To participate, each pharmacy must complete an Outcomes MTM Network Participation Agreement.
• Go to www.getoutcomes.com
• Click on the tab labeled “Pharmacists” at the bottom of the screen
• Select “Pharmacy Contracting”
Pharmacist Training: To be eligible to provide these MTM services and receive professional fees, pharmacists must complete the Outcomes Personal Pharmacist training program. The Outcomes Personal Pharmacist Training program is broken into 8 interactive modules. Running time is approximately 1 hour. The web-based training program is available at no cost. The CD is available for $10.
• Go to www.getoutcomes.com
• Click on the tab labeled “Pharmacists” at the bottom of the screen
• Select “Pharmacist Training”
• Select “Online Pharmacist Training” or “Order CD-ROM”
• After completing all of the training modules, you will need to take the
“Post-Test” to complete the registration process.
Does your pharmacy have eligible patients?
• After you have completed the training program, the system will automatically request access to the pharmacies you have entered during registration. Once you have been granted access to a pharmacy, you will be able to view that pharmacy’s list of Outcomes-eligible patients.
• To access a pharmacy’s list of Outcomes-eligible patients, log in to your profile and select the “Patients” tab on the left.
• Select a patient to review their electronic chart and begin the process of electronic claim submission.
Outcomes® MTM Billing Example and Specifics
All employees and health plan members are eligible for a full menu of face-to-face MTM services. The covered services and the corresponding professional fees are additive and appear below:
· Prescriber Consultations (i.e. Formulary or Drug Related Problem) $20.00
· Comprehensive Medication Reviews (CMR) $50.00 + other billable encounters
Simply put, pharmacist will be able to bill for services that are currently uncompensated such as consultation phone calls placed to a prescriber for formulary reasons, unsafe doses or interactions.
Example: Medication not covered by patient’s insurance formulary. Action: Pharmacist consults Physician and medication is changed. Pharmacist provides and educates patient on new medication. Patient receives a follow-up call in 3 days to monitor satisfaction with new medication.
Billable services:
Physician Consultation $20.00
Patient Education & Monitoring on new medication $10.00
Targeted Intervention Program (TIP®): In addition to pharmacist-identified services, Outcomes also works to assist pharmacists with the identification of potential MTM services. Known as TIPs, these interventions may target cost savings opportunities for the patient, inappropriate compliance, potentially contraindicated drugs, and other drug therapy problems. On a periodic basis, Outcomes uploads TIPs to a queue in the online documentation platform. These TIPs are also distributed by mail and/or fax to pharmacies dispensing prescriptions to Outcomes-eligible patients. Pharmacists may respond to TIPs by fax or mail before contracting and training are complete. TIPs are a great way to get started with Outcomes MTM services.