Medication Therapy Management (MTM), CMM,
Other innovative services questions with accurate
answers
Compare and contrast different electronic platforms to perform MTM
Ans✓✓✓ Mirixa and Outcomes have combined to form
OutcomesMTM under Cardinal Health
Other platforms also available
Compare MTM and CMM Ans✓✓✓ CMM:
- Assessment of clinical status: Included (e.g. evaluating blood pressure
in patients on antihypertensive treatment) -Core elements: Not as
defined but there are more - Follow-up: Incorporates a clinically
appropriate follow-up evaluation to assess the patient's progress toward
treatment goals
-Health care provider specification: Requires collaboration among
members of the health care system
-How patients are referred: Depends on individual program
-Responsibility: Under collaborative protocol, pharmacist perform
patient assessments, order drug therapy related laboratory tests,
administer drugs; and select, initiate, monitor, continue and adjust drug
regimens
MTM:
-Assessment of clinical status: More centered around patient's
medications
-Core elements:
,1. Medication therapy review (MTR)
2. Intervention and/or referral
3. Personal medication record (PMR)
4. Medication-related action plan (MAP)
5. Documentation and follow-up
-Follow-up: Additional follow-up may not receive any added
compensation
- Health care provider specification: Legislation does not specify which
health care providers should provide MTM
-How patients are referred: Limit to disease states (≥3 out of 5)
(HTN,DLP, CHF,DM,OP), number of medications (≥8), annual med
spending (2016: $3507, 2017: $3919) and Medicare eligibility
-Responsibility: Does not require a formal collaborative practice
agreement between a pharmacist and a prescriber
Define patient demographics that qualify to receive MTM Ans✓✓✓ -
Those with chronic diseases and diseases common in older patients
(hypertension, dyslipidemia, congestive heart failure, diabetes,
osteoporosis)
-High number of medications (>8)
-High annual medication spending
-Medicare eligibility
Define the 5 core elements of MTM Ans✓✓✓ 1. Medication therapy
review (MTR)
2. Intervention and/or referral
, 3. Personal medication record (PMR)
4. Medication-related action plan (MAP)
5. Documentation and follow-up
Describe reimbursement for MTM services Ans✓✓✓ -Current
procedural terminology (CPT) codes
-Developed by the American Medical Association and updated yearly
-Accepted as a means for communicating and documenting medical
services by physicians, nurses, and other health care providers
-HIPPA transactions regulations require that all professional health
services are to be coded using health professional service codes, such as
CPT codes
-Most CPT codes need to be billed through the prescriber
-Three new CPT codes allow for pharmacist billing
-Can be high if you do comprehensive medication review, or low if the
patient refuses
Describe reimbursement options for CMM Ans✓✓✓ Fee-for-service
• Has been the most common
• Based on type & complexity of service
• Might be replaced → PCMHs or ACOs
Pay-for-performance
• Higher rate of payment when patients meet predefined health outcomes
• Other variables can affect outcomes
Other innovative services questions with accurate
answers
Compare and contrast different electronic platforms to perform MTM
Ans✓✓✓ Mirixa and Outcomes have combined to form
OutcomesMTM under Cardinal Health
Other platforms also available
Compare MTM and CMM Ans✓✓✓ CMM:
- Assessment of clinical status: Included (e.g. evaluating blood pressure
in patients on antihypertensive treatment) -Core elements: Not as
defined but there are more - Follow-up: Incorporates a clinically
appropriate follow-up evaluation to assess the patient's progress toward
treatment goals
-Health care provider specification: Requires collaboration among
members of the health care system
-How patients are referred: Depends on individual program
-Responsibility: Under collaborative protocol, pharmacist perform
patient assessments, order drug therapy related laboratory tests,
administer drugs; and select, initiate, monitor, continue and adjust drug
regimens
MTM:
-Assessment of clinical status: More centered around patient's
medications
-Core elements:
,1. Medication therapy review (MTR)
2. Intervention and/or referral
3. Personal medication record (PMR)
4. Medication-related action plan (MAP)
5. Documentation and follow-up
-Follow-up: Additional follow-up may not receive any added
compensation
- Health care provider specification: Legislation does not specify which
health care providers should provide MTM
-How patients are referred: Limit to disease states (≥3 out of 5)
(HTN,DLP, CHF,DM,OP), number of medications (≥8), annual med
spending (2016: $3507, 2017: $3919) and Medicare eligibility
-Responsibility: Does not require a formal collaborative practice
agreement between a pharmacist and a prescriber
Define patient demographics that qualify to receive MTM Ans✓✓✓ -
Those with chronic diseases and diseases common in older patients
(hypertension, dyslipidemia, congestive heart failure, diabetes,
osteoporosis)
-High number of medications (>8)
-High annual medication spending
-Medicare eligibility
Define the 5 core elements of MTM Ans✓✓✓ 1. Medication therapy
review (MTR)
2. Intervention and/or referral
, 3. Personal medication record (PMR)
4. Medication-related action plan (MAP)
5. Documentation and follow-up
Describe reimbursement for MTM services Ans✓✓✓ -Current
procedural terminology (CPT) codes
-Developed by the American Medical Association and updated yearly
-Accepted as a means for communicating and documenting medical
services by physicians, nurses, and other health care providers
-HIPPA transactions regulations require that all professional health
services are to be coded using health professional service codes, such as
CPT codes
-Most CPT codes need to be billed through the prescriber
-Three new CPT codes allow for pharmacist billing
-Can be high if you do comprehensive medication review, or low if the
patient refuses
Describe reimbursement options for CMM Ans✓✓✓ Fee-for-service
• Has been the most common
• Based on type & complexity of service
• Might be replaced → PCMHs or ACOs
Pay-for-performance
• Higher rate of payment when patients meet predefined health outcomes
• Other variables can affect outcomes
