WASHINGTON, DC – The Journal of the American Pharmacists Association (JAPhA®) today announced the publication of two special features evaluating the adoption and billing processes of the Minnesota Department of Human Services (DHS) medication therapy management (MTM) program. The Special Features appear in JAPhA’s May/June issue.
Minnesota has been among the leading states in developing and implementing MTM services. Early work to define and develop pharmaceutical care practices was accomplished from 1992 to 1997 in the Minnesota Pharmaceutical Care Project. This initial work spawned the creation of MTM services, which have been incorporated into many health care programs. In 2005, the Minnesota State Legislature charged the Minnesota DHS to compensate pharmacists for MTM services provided to eligible individuals receiving health care benefits from Minnesota Health Care Programs (MHCP), thereby creating the first statewide MTM program.
Introductions to the special features appear below. Full-text articles are available free of charge on the Journal’s website at www.japha.org or copy can be requested by email from firstname.lastname@example.org.
Adoption of medication therapy management programs in Minnesota: 2006–2011
Steven Larson, 2013 PharmD Candidate; Sara Drake, BSPharm, MPH, MBA; Lowell Anderson, BSPharm, DSc, FAPhA; Tom Larson, BSPharm, PharmD, FCCP
Synopsis: The Minnesota DHS has aided in the process of improving access to MTM by compensating pharmacists since 2006. In each of the first six years of the MTM program, the number of claims, number of pharmacists submitting claims, and dollars compensated all increased. During 2011, 76 pharmacists were compensated a total of $210,716 for 2,427 claims. Of these claims, 1,009 were initial visits and 1,418 were follow-up visits. During 2011, the percentage of eligible patients provided services was estimated to be 5.7- 7.6 percent.
Analysis: Additional strategies to remove barriers to providing MTM should be considered. As most services in medical assistance programs are free of cost to enrollees, providing incentives for participating in MTM is difficult. Therefore, transitioning from an opt-in to an opt-out program may not be a practical approach to expanding services. Although patient use of the MTM program continues to increase at a promising rate, pharmacist participation has increased only modestly during the previous 3 years. Recruiting new pharmacists to this growing market is important. Increasing involvement from large health systems, resolving the pharmacist shortage, and further standardizing billing practices may help improve these numbers.
Minnesota Department of Human Services audit of medication therapy management programs
Stephanie Smith, PharmD; Penny Cell, CPC, CPMA; Lowell Anderson, BSPharm, DSc, FAPhA; and Tom Larson, BSPharm, PharmD, FCCP
Synopsis: Prompted by reports from physician services that pharmacists were billing for more units and coding medication therapy management (MTM) services at a higher-than-appropriate level, the Minnesota DHS conducted an audit of claims submitted to Minnesota Health Care Programs for patients receiving MTM services from Minnesota pharmacists. The auditor verified whether the Current Procedural Terminology (CPT) codes billed matched the actual number of medications, conditions and drug therapy problems assessed during MTM encounters.
Analysis: Six main themes were identified from the audit findings: (1) concerns with visit time, (2) assessing complexity of conditions and medications, (3) appropriate documentation, (4) defining drug therapy problems, (5) working with the CPT code billing table, and (6) understanding procedure for notice and appeal. When billing for a medication, condition, or drug therapy problem, everything for which is being billed must be clearly assessed or rationalized in the documentation note and easily understood by the auditor, not only for audit purposes but also for demonstrating quality of service.
About the Journal of the American Pharmacists Association
JAPhA is the official peer-reviewed journal of the American Pharmacists Association (APhA). JAPhA is a forum for original research, reviews, experiences and opinion articles that link science to contemporary pharmacy practice to improve patient care. It provides information on pharmaceutical care, drug therapy, diseases and other health issues, trends in pharmacy practice and therapeutics, informed opinion and original research. For more information, please visit www.japha.org.
About the American Pharmacists Association
The American Pharmacists Association, founded in 1852 as the American Pharmaceutical Association, is a 501 (c)(6) organization, representing more than 62,000 practicing pharmacists, pharmaceutical scientists, student pharmacists, pharmacy technicians and others interested in advancing the profession. APhA, dedicated to helping all pharmacists improve medication use and advance patient care, is the first-established and largest association of pharmacists in the United States. For more information, please visit www.pharmacist.com.