10/23 - MTM & Documentation of Pharmacist Services

Provider

an individual healthcare professional who delivers services to patients and is eligible to bill medical insurance for those services

Are pharmacists recognized as providers under medicare b?

no, this limits ability to bill for clinical services

Credentialing

the process of verifying a healthcare professional’s qualifications

Privileging

the process of granting permission to perform specific services within an organization or payer network

What are credentialing and privileging processes essential for pharmacists to participate in?

medical billing and payer networks

Medication therapy management

partnership between the pharmacist, patient, and other professionals promoting safe and effective use of medications and helps patients achieve targeted outcomes from medication therapy

Medication therapy management impact

improves patient outcomes, reduces risk of adverse events, and reduces healthcare costs

Comprehensive medication review

a systematic process for collecting assessing medication therapies to identify medication-related problems

Targeted medication reviews

address specific or potential medication-related problems

Medical billing

a provider submits a claim for reimbursement to the medical insurance benefit based on services provided to a patient

Pharmacy billing

pharmacy submits a claim to the pharmacy benefit, typically for a product

What must all medical records contain?

• first last name, dob, gender

• date of service and provider name

• valid signature, credential, and date of signature by provider

What must be documented for each patient encounter?

• reason for the encounter

• relevant history, physical exam findings, prior diagnostic test results

• medical poc

What are formats of clinical service documentation?

• SOAP note

• intake forms

• patient history & labs

• pharmacist eCare plan

Where are services documented?

• electronic health records

• pharmacy management system

• third party