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MTM NEWS
Humana contracts with Outcomes
Humana has contracted with Outcomes so that pharmacists in Washington can provide pharmaceutical care for some of their patients. Go to our Humana page for more information.
Mirixa Corporation and the APhA Foundation form partnership
APhA Foundation and NCPA Join Forces to Deliver Patient Care via Single Platform, MirixaPro
October 9, 2008- Mirixa Corporation and the American Pharmacists Association (APhA) Foundation, the creator of the Diabetes Ten City Challenge and a partner in the Asheville Project®, jointly announced today that they will form a newpartnership that will deliver all of APhA Foundation’s HealthMapRx commercial programs via Mirixa. MirixaPro? will be the platform of choice for all existing and future APhA Foundation commercial programs delivered through pharmacy. HealthMapRx
June 12, 2008 The Washington State Department of Health Board of Pharmacy recently granted the UW School of Pharmacy a license to open a nondispensing, medication-therapy-management (MTM) pharmacy. It is the first of its kind in Washington state. This new pharmacy is an integral component of the Department of Pharmacy’s effort to develop an MTM training program within the School. MTM is a service that pharmacists provide to high-risk patients — in which they work with clients to help them improve their medication and general health regimens.
Drs. Annie Lam and Peggy Odegard, named Herb and Shirley Bridge endowed professors this past fall, are using the funds from the professorship to create this program. Lam and Odegard saw a need for it after learning that some Washington pharmacists have been overwhelmed by MTM requests since Medicare Part D went into effect in January 2006. Given that pharmacy students have also requested MTM training in recent years, this seemed like the right time to pursue this project. Under Medicare Part D, certain beneficiaries who spend more than $4,000 on annual prescription drugs and who have multiple chronic diseases qualify for billable MTM services. The School is collaborating with the Washington State Pharmacy Association to bridge the service gap for practitioners who have more requests for these Medicare-related services than they can satisfy. Ultimately, the program seeks to help community pharmacists meet the demand while also creating an effective teaching resource for the School of Pharmacy.
“Our goal is not to be competitive with our professional colleagues who are practicing pharmacists, but rather to provide them with MTM support while also assuring our graduates are well-prepared to provide these services,” says Odegard. The School of Pharmacy’s MTM program will focus on three primary areas — implementing an MTM curriculum for students, creating an onsite MTM consulting service, and conducting research. Some of the initial research, says Odegard, will assess best practices for pharmacists providing these services to older adults. If all goes according to plan, the School will begin offering the training classes to students this fall.
Patient Care Services: Reimbursement is HERE…NOW!
The Washington State Pharmacy Association (WSPA) HealthWise Pharmacist Network has been working hard to negotiate reimbursement for patient care services provided by pharmacists. We are happy to announce four tremendous opportunities for reimbursement for pharmacy care services related to medication therapy management. Pharmacists can currently receive reimbursement for MTM services from three payers: 1) Medicare Part D Community Care Rx via Mirixa, 2) Washingon State Healthcare Authority Uniform Medical Plan via Medication Pathfinder and 4) Medicare Part D Humana. If you are interested in joining the HealthWise Pharmacists Network, please contact Jenny Arnold at jarnold@wsparx.org.
Bill Medicaid for Professional Services and DME ONLINE!
Washington State WAMedWeb offers the ability to submit 837 professional claims (the HIPAA electronic version of what is known on paper as the HCFA/CMS 1500) via the internet web portal. This site will allow pharmacists to submit professional services that Medicaid covers, and DME/non-DME claims. However, it does not support the submission of pharmacy claims. WAMedWeb provides the tools and resources to help healthcare providers conduct business electronically with Washington State Medicaid. Go to http://wamedweb.acs-inc.com to register to use WAMedWeb. A WAMedWeb Tutorial is also available at http://fortress.wa.gov/dshs/maa/WaMedWebTutor/.
Apply for Your National Provider Identifier (NPI) today!
All health care providers, including pharmacists, should apply for their National Provider Identifier (NPI). The NPI will replace health care provider identifiers in use today in standard health care transactions. The health plans with whom you do business will instruct you as to when you may begin using the NPI in standard transactions. All HIPAA covered entities except small health plans must begin using the NPI on May 23, 2007; small health plans have until May 23, 2008. For additional information, to complete an application, and to access educational tools, visit https://nppes.cms.hhs.gov on the web.
Billing Codes Developed for Pharmacists' Professional Services
ALEXANDRIA, Va. (July 31, 2006) - The Pharmacist Services Technical Advisory Coalition (PSTAC) has succeeded in gaining important revisions in the Health Care Provider Taxonomy Code List for Pharmacy Service Providers and Pharmacy Suppliers. The Code List is a set of unique alphanumeric codes, 10 characters in length that describes the types of patient care services provided by health care providers and is structured into three distinct "Levels," including Provider Type, Classification, and Area of Specialization. PSTAC was founded in 2002 to improve the coding infrastructure necessary to support billing for pharmacists' professional services.
Medication Therapy Management Services CPT Billing Codes
The American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel has approved three CPT billing codes for pharmacists to use to bill third-party payors when providing medication Therapy Management Services (MTMS) were released July 1, 2005 and became effective January 1, 2006. The codes may be used to bill any health plan that provides a benefit for MTMS, including those covered under the new Medicare Part D Prescription Drug Benefit. Third-party payors will individually determine the reimbursement rates and criteria for MTMS.The billing codes are intended to be used to bill third-party payors only for MTMS performed face-to-face between a pharmacist and a patient:
Code 99605: the billing code for a first-encounter service performed face-to-face with a patient in a time increment of up to 15 minutes
Code 99606: the code for use with the same patient in a time increment of up to 15 minutes for a subsequent or follow-up encounter
Code 99607: an add-on code which may be used to bill for additional increments of 15 minutes of time to either of the preceding codes
MTM services may be initiated at the request of the patient and/or caregiver, payer, pharmacist and/or other healthcare provider. The MTMS codes are not to be used to describe the provision of product-specific information (e.g., patient medication leaflets) at the point of dispensing. Similar to the documentation requirements for other health care providers the following elements are required to verify the service provided and are dependent on the type and level of MTMS: review of the pertinent patient medical history; medication profile (prescription and non-prescription); interventions and recommendations for optimizing medication therapy; referrals, treatment compliance; communications with other healthcare professionals; administrative functions (including patient and family communications) relative to the patient care; and/or follow-up care.
For more information, please visit the AMA's CPT info and education page
PSTAC also secured a Place of Service (POS) code to be used by pharmacists billing for services in a pharmacy setting. Beginning October 1, 2005 pharmacists may use POS Code 01, "Pharmacy." This new code supplements other POS codes typically used by pharmacists such as Code 11, "Office," or 99, "Other Place of Service."
Pharmacists' and 'Incident to' CPT Codes
The CPT codes for services provided incident to a physician's service during an office or outpatient visit are based on time and complexity. Some of these codes are briefly explained below.
99201—Initial evaluation and management of the patient with a minor or self-limited problem; 10 minutes
99211—Subsequent evaluation and management of the patient with a minimal problem; 5 minutes
99212—Subsequent evaluation and management of the patient with a minor or self-limited problem; 10 minutes
99213—Subsequent evaluation and management of the patient with a problem of low or moderate severity; 15 minutes
99214—Subsequent evaluation and management of the patient with a problem of moderate or high severity; 25 minutes
99215—Subsequent evaluation and management of the patient with a problem of moderate or high severity; 40 minutes
See a Master Code List with explanation.
Pharmacist Services Technical Advisory Coalition was a leader in securing these codes. For a complete discussion on these codes and PSTAC check out PSTAC Frequently Asked Questions.
UW School of Pharmacy Receives License for Nondispensing Pharmacy
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