Pharmacy Reimbursement: Make the Most of MTM

By definition, Medication therapy management (MTM) is medical care provided by pharmacists whose aim is to optimize drug therapy and improve therapeutic outcomes for patients. Due to their specialized training and unique insight Pharmacists today are playing a pivotal role in improving patient outcomes by recommending suitable medications and providing other allied services like direct patient care, coordinating care with the physician all under the scope of practice established across state. Their focused training in drug therapy puts Pharmacists in a position where they can access a patient’s health and medication needs and offer unique solutions for their health problems. However, the mechanisms of billing a pharmacist’s services that fall out of the medication dispensation exercise are still unstandardized across the healthcare system in the country. It has been observed that Pharmacist’s rarely get reimbursed for whole gamut of services that are offered under Medication Therapy Management. Here are some things to keep in mind when you are trying to make the most of MTM while seeking Pharmacy Reimbursements:

Take Pre & Post Consultation Work into Account while Billing

Highly time consuming and often unaccounted pre-consultation work like putting together patient’s reports and records and post consultation work like effective communication, claim preparation and post-submission follow-ups are an integral part of Pharmacy Services. Today, Pharmacies are trying to strategize and increase their revenues by providing various additional services like in-depth consultation and counseling followed by other extras like customized drug packing for the ease of patient and recurrent follow ups. “Target MTM” endeavors to focus on a specific patient problem with a medication. It is important that all these services are intricately noted and billed to enhance the revenues of the organization. Revenue Management for Pharmacy Billing Services can be done well only when all the services provided by a pharmacist are accounted for.

Put Established CPT/ICD-10 Codes to Use

With the state recognizing Pharmacies as an indispensable healthcare provider, it is time that they can bill their services directly .To achieve a profiteering Pharmacy practice, it is important that you use CPT/ICD-10 codes efficiently. Various pharmacy billing specialist use CPT codes to optimize reimbursements for pharmacy services like analyzing patient’s clinical history, charting out a medication profile followed by recommending patients strategies to enhance compliance with prescribed therapy. Adhering to the guidelines of using CPT codes allows a pharmacist to analyze Drug-related needs, figure Drug therapy problems faced by patients and also plan around the Complexity-of-care. Using pharmacy billing software helps you record the type and length of service provided during initial visit, follow up visit and additional time spent through appropriate codes to optimize your revenues.

Modify Your Billing Procedure

Billing for pharmacy services like MTM requires payers to reimburse claims made for eligible patients under Medicare Part D. Make sure you put your fees out on display in the form of an itemized menu to make the patients aware of what is the visit going to cost. Let the patient know about the provisions like availability of a receipt that can be used to submit a claim; however that goes without the guarantee that such a claim would be honored. In which case, the patient will have to pay for the service in full. It is also important that you have your National Provider Identifier number (NPI). The first and foremost step towards a successful pharmacy practice thus begins with hiring front and backend staff that knows the govt. Regulations in an out and has the caliber to put such knowledge to use and grow your profits. Outsourcing pharmacy billing services to specialized agencies that understands the needs of your business and is well-equipped in providing for them is also a good option if you lack the technical know-how required to do the job.