1. How to Justify and Bill for Inpatient MTM Services
Deborah Sanchez, PharmD, BCPS,
MHA (Candidate 2015)

2. Objectives Describe services eligible for inpatient MTM
Analyze regulations
Establish a coding system
Calculate the costs
Devise a billing process
Formulate a plan for implementation
It is my experience that not many hospital pharmacies are currently billing for inpatient MTM services?
It is my hope that by the end of this presentation you will be able to
describe the necessary steps for establishing an inpatient MTM service
be familiar with related state and federal regulations;
be able to calculate costs associated with providing service;
be able to establish a coding system and billing values;
and be able to set up a way to capture and bill for eligible services.
My hope is that with this information you will be able to formulate your own plan for implementation of inpatient MTM billing.

3. Opportunity
In today’s cost-conscious environment where every department is expected to do more with less while providing exceptional patient care, implementing effective revenue-saving initiatives is especially vital. Thus, hospital pharmacists are continually tasked with re-evaluating systems and processes to capture revenue wherever possible. Charging for inpatient medication therapy management (MTM) services is one effective strategy, but it is rare to encounter an inpatient pharmacy that bills for MTM services, as MTM is typically interpreted as only an outpatient program.
However, inpatient cognitive services provided by pharmacists can be billed to insurers, and this practice has the potential for substantial financial return, generating revenue that can be used to support the organization and facilitate growth of the clinical program. Consequently, hospital pharmacists should consider the clinical and financial benefits of implementing an inpatient MTM service.
Asante Rogue Regional Medical Center is a 378-bed regional referral and trauma center, and part of the three-hospital system. Rogue specializes in heart and stroke care, orthopedic services, cancer care, and offers a range of additional services, including 3 critical care service lines. Rogue Regional Pharmacists have provided MTM services to inpatients, and billed for these services, for the past seven years.
In 2007, the inpatient pharmacy department wanted to highlight its value to the rest of the institution. Leaders sought to advance pharmacy practice, and “raise the bar” for practicing pharmacists. At that time inpatient clinical pharmacists were performing fall consults, length of stay reviews, kinetic monitoring, drug dosing, and other monitoring at the request of a physician. Documentation was limited to a couple lines in the chart. Pharmacists had limited visibility to the medical staff and no visibility to patients.
The pharmacy department developed and implemented a program to perform and bill for inpatient Medication Therapy Management (MTM) services. The purpose of the program was to optimize patient care and gain financial reimbursement for cognitive services already being provided.
Pharmacy management was not aware of any other hospital or health system billing for inpatient MTM services at the time of implementation. After some research it was discovered that inpatient services do qualify and meet billing criteria contrary to the usual assumption that MTM is restricted to outpatients in the community setting. Therefore, a system was developed to document and bill for these inpatient services.
The pharmacy set out with several goals including
improving visibility of pharmacists to patients and the rest of the healthcare team;
supporting appropriate medication use through pharmacist intervention;
increasing pharmacist-managed consults for drug dosing and monitoring;
preventing adverse drug events;
managing patient’s response to therapy; and
providing education to the patient or caregiver.

4. At my hospital, pharmacy consults occur over 1600 times times a month, of these approximately 40-50% are eligible for MTM billing. This chart shows a snapshot of the types of consults occurring in the MTM program.
Some common MTM consultations include:
 Formal Antimicrobial stewardship effort:
This includes a protocol that covers pharmacist at 72 hours to review the indication and expected duration of antimicrobial therapy. This is designed as a time to make appropriate recommendations for treatment based on the available clinical data, redundant combinations, or drug-bug mismatch
We also have an automatic protocol for IV to PO conversion
We are consulted to manage TPN monitoring and adjustment via an order set
We have a protocol for automatic consults for Kinetic dosing (vanc, aminoglycosides)
We have a Renal dosing protocol that covers adjustment of a variety of medications, but primarily antimicrobials and anticoagulants.
We have a protocol for anticoagulation monitoring, adjustment, and patient education for warfarin
We have several protocols for patient discharge education. These include high-risk medications like U-500, anticoagulants, and for patients at high risk of readmission such as those with HF or pneumonia.
And, we take a variety of consults for other services from the medical staff
To be considered billable, an MTM must have an associated protocol, order, or provider consult.
For example, an order for warfarin generates an MTM consult based on the pre-established protocol, allowing pharmacists to dose and monitor all warfarin in the hospital. Upon receipt of the order, the pharmacist reviews the patient’s medical record and conducts an assessment. The pharmacist visits the patient briefly to discuss the care plan, including any changes to therapy or monitoring. The visit and the plan of care are then documented in the medical record.

5. 4 Step Solution
Regulations
Coding
Train
Capture
It took us four basic steps to implement the inpatient MTM program.
First we reviewed state and CMS regulations,
Then, we worked with the finance department to evaluate how to code services for billing.
Next, we trained the pharmacy biller and pharmacists on the process.
Lastly, we established a method for charge capture.

6. Rules and Regulations State Board of Pharmacy
Centers for Medicaid and Medicare (CMS)
Documentation
Face-to-face visit
Order or consult
Step 1: Evaluate Rules and Regulations
Each state has their own specific rules surrounding requirements for MTM services.
In Oregon, the Board of Pharmacy specifically requires documentation be in the SOAP format in the medical record for MTMs.
Other requirements come from CMS – such as the face-to-face visit with the patient for each consultation.
Thus our hospital pharmacists conduct face-to-face patient visits and document those visits in the SOAP format in the medical record.
They also make sure to start and end their progress notes with statements that confirm face-to-face contact, for example, I visited with the patient and The patient understood the plan of care.
Additionally, all clinical services billed as MTM must be ordered by a physician. That can mean a protocol approved by the appropriate committee, orders in order sets, or an individual physician consults for specific services not otherwise covered by protocol.

7. Billing Codes MTM Level CPT* Rev Code** 1 99211 940 2 99212 3 99213 4
99214 5
99215
The 2nd step is to establish billing codes.
Once requirements to meet legal criteria were clear, directors from pharmacy and finance discussed the options for billing. Evaluation and Management (E/M) codes were chosen because they are based on complexity, not time spent interviewing the patient or completing documentation.
The pharmacy and finance departments collaboratively determined charge master billing values for each level of service. I worked with finance last year to update those values based on an activity-based-costing analysis that looked at the cost of the pharmacist’s time to perform the assessment, interview the patient, write or enter medication or lab orders, and document the consult. The cost of billing was also included.
(p)
There are several billing codes that could apply to MTM services.
Code covers complex coordination of care without a patient visit, and
Code is the same except it includes a 1 hour patient visit per month.
In the inpatient setting, pharmacists see patients for MTM services almost daily. Thus, these new codes (CCCC and TCMS) (99487, 99488) do not work for inpatient MTM.
The CPT codes can be used to categorize the pharmacy services. These codes base billing values based on establishment of the patient and duration of the visit. These codes are feasible for inpatient use if an organization decides to use them.
Our organization chose to use because these codes identify the pharmacist as a care ‘provider’ while do not. These codes are based on complexity instead of time. There is no reimbursement advantage over in respect to Medicare, since neither set of codes are covered.
The CPT codes are basically used to categorize our work by complexity and determine the amount to bill.
The organization uses these codes for work done by clinical dieticians, respiratory therapists, and pharmacists.
Finance then assign the sum value to a revenue code, 940, “Other Therapeutic Service”.
This revenue code is then sent across to Medicare, private insurance, etc for payment.
We do not send the CPT codes to payers for inpatient care.
Payment
Medicare of course doesn’t pay for any of these items because they pay based on MS-DRG.
Insurance however, sees it as a charge and pays for it at negotiated rates. We are not at risk of audit for this.
As an aside, Medicare takes into consideration the ‘cost’ of care in regions and the nation. If all inpatient pharmacy services were billed it might affect the base rate. (but I’m no expert here and will pursue further discussions with finance at a later date to understand better).
I am no expert here, and all the data related to coding was provided via a consult with the finance director.
This is how it works based on consultation with finance:
* CPT = Current Procedural Terminology
** Revenue Code 940 = therapeutic services

8. Complexity of Codes
Our inpatient MTM Evaluate and Manage, or E&M codes range from Level 0 to Level 5 in complexity(please see your Handout).
If an MTM is coded as Level 0 it means that the consult did not meet the criteria of a face-to-face visit with the patient, or did not have an order or protocol associated with it and is not reimbursable.
Level 1 is considered a simple assessment resulting in no change to current treatment and little to no follow-up. An example would be a fall consult where a pharmacist reviews the patient’s medications and determines that no change in therapy is recommended to reduce fall risk. Straight-forward medication reconciliation would also fall under the Level 1 category.
As the service increases to Level 2, the consultation is still brief and may involve assessment of the patient’s laboratory data, including evaluation of renal function, but require no change in therapy.
Level 3 involves medical decision-making that would be considered moderately complex, such as providing patient education for anticoagulation therapy, adjustment of medication doses based on patient response or pharmacokinetic parameters. For example, a Total Parenteral Nutrition (TPN) follow-up consult, or consult for patient education would fall under this category.
Patients who qualify for Level 4 service require more in-depth management by a pharmacist such as initiation of warfarin or an aminoglycoside antibiotic which involves dosing, monitoring, and other clinically analysis.
Level 5 is distinguished from the others by medical decision-making of extremely high complexity that usually covers multiple critical issues – and according to the interpretation of my organization’s finance department is NOT billable by a pharmacist due to the need for head-to-toe physical assessment.

9. SOAP Note Documentation
The 3rd step in the process is training.
MTM documentation involves creating an ongoing, patient-specific, chronologically ordered record that describes all care provided in an established, standard format. (or SOAP note). This documentation facilitates communication between the pharmacist and other health care providers; improves patient outcomes; enhances continuity of care; ensures compliance with laws and regulations related to maintenance of patient records and provision of MTM services. It also protects against professional liability; and captures services provided for billing.
When we started the program, our pharmacists were relatively new to conducting an in-person interview and writing complete SOAP notes that would be sufficient for billing. Thus, pharmacists were given education on the definitions of each MTM level and the requirements for the visit and documentation.
We taught them that notes needed to contain specific phrases that document face-to-face contact such as, “I spoke with the patient” in the SUBJECTIVE part of the note and “The patient verbalized understanding” in the PLAN part of the note.
We determined that to meet billing criteria for a ventilated patient who is unable to speak, a patient visit is still required. At our organization, this is conservatively interpreted. So, pharmacists must instead visit with the patient’s family and document that discussion in the medical record.
Education on the program was provided in staff meetings and specific continuing education sessions. A reference document was created that outlined the process, defined the billing levels, and detailed how to complete the MTM process in the computer system.
After the program was established, the pharmacy department received feedback from the finance department on how to improve the notes and reduce the risk of audit failure.
First, they encouraged using standardized note titles to catch the attention of the biller. Thus, we use words in the title like “Formal” or “consult” or “per protocol” to designate that an order is in place for the MTM.
We try to avoid too much ‘fluff’ in the notes because this raises red flags for auditors. Thus, we strive to only include data that is DIRECTLY related to the assessment. Other unrelated data is eliminated.
Recently we implemented an electronic medical record that has allowed us to develop standardized note templates which have helped with inclusion of pertinent data.
(P)
We had done many educational consults prior to implementing the MTM program. However, the new program required much more frequent face-to-face interactions.
Pharmacists initially felt hesitation about visiting all of their patients. This was a change in their workflow, and an additional task.
Their primary concern was that they initially didn’t feel they could get in and out a patient’s room effectively.
So, we worked on how to conduct a short visit. The organization later emphasized the use of Studor’s AIDET method.
However, after 7 years the pharmacists are pros at patient visits and documentation.
(Acknowledge, Introduce, Duration, Explanation, Thank you)

10. Medical Billing Process
CPT and ICD Coding
Charge Posting
Claim Submission
Payment Posting
Patient Care
Document Care
Charge Capture
The 4th and final step of implementation involved establishing a reporting system to collect MTM progress notes written by pharmacists is to process them for billing.
When we initially established billing, the actual bill was generated in central pharmacy by staff trained to provide technical billing assistance. This required several steps by the pharmacist to assure the biller received a copy of the note from which to bill. As time went on, the organization implemented an electronic medical record and the reporting and billing process became simpler. Now the biller runs a daily report that captures all ‘pharmacist authored’ progress notes. The biller then must pull each pharmacist progress note and scan the title which should include specification that the services have been ordered by a physician or are conducted under protocol (eg, vancomycin dosing per protocol). The biller then scans the first few lines of the note to assure the pharmacist visited with the patient. Once these criteria are met the biller reviews the note in more detail to determine the level of service, 1-5.
Currently, our billers document their MTM reviews, including patient name, pharmacist name, date of service, MTM level, MTM charge, MTM type and payers billed on a spread sheet. Managers periodically audit the billers’ records to assess patterns and provide pharmacists feedback on the quality of their MTM services and discuss reasons that charging could not occur (eg, failure to document the patient visit).

11. Allocation Rate ($/min) Patient visit time (time)
Billing Premise
Activity
Cost Driver
MTM 1 Time Consumption
Allocation Rate ($/min)
MTM 1 Cost/Visit
Assessment Time (min)
Pharmacist’s time 10
$1.33
$13.30
Patient visit time (time) 5
$6.65
Writing orders (time)
Documentation (time)
Billing (time)
Biller’s time 3
$0.70
$2.10
Total cost/visit
$35.35
We worked with finance to assess a fair value for the initial billing amounts.
We also reassess periodically to assure proper values.
In 2013, I conducted a cost benefit analysis to determine how much it costs to provide the services in pharmacist time and assure we billed accordingly.
The value of this analysis was that it helped to approximate the cost of providing each level of service, and could be considered when adjusting the billing value. Pharmacist productive time was estimated to cost the organization $1.33 per minute based on a productive time calculation (this includes consideration for benefits, ETO and sick time).
I based the time estimates for providing the service on a small time survey sent to practicing pharmacists.
This example shows that it costs approximately $35 to provide a level 1 MTM. Each level of MTM cost (level 1-5) was calculated, and then I presented these costs with an estimated mark up to the finance director. The discussion led to a large adjustment. Many of our billing values had not been reassessed for 6 years, so the increase was over 100% for each level of service. Lessons learned, reassess billing values annually.
Billing values should start from this premise at each individual organization
What is important to note, however, is the actual additional time required for a level 1 consult is 5 minutes of pharmacist time. This is the time it takes to conduct the patient visit. Additionally, it takes the biller approximately 3 minutes to process a bill.
We conducted all other components of the clinical service prior to implementation of the MTM program.
Finally, audit the process regularly…
We used audit information to foster continuous quality improvement of the program by providing feedback to pharmacists on the levels being billed based on the content of the note, and if any notes fail to meet billing requirements. Pharmacists better understand the requirements and have learned the best way to organize their notes and perform consults in order to ensure the maximum level of patient care and reimbursement through this process. .

12. May 2014 Billable Consults
The organization billed for over 800 consults in May this year. This roughly equates to 50% of the 1650 pharmacy consults documented and $160,000 in NPSR for that month!
Each patient may have 1 MTM billed each DAY! One and only one bill is allowed per day. If more than one pharmacist cares for the patient each day – only one service will be billable. We moved away from individual specialties, such as TPN service, as a result. We now expect each practitioner to be capable of providing complete care. .
A pharmacy residency project in 2012 sought to further increase MTM billing specifically for critical care patients. Pharmacists were offering clinical services without a physician order which made them ineligible for billing. Therefore, a protocol was developed, approved, and implemented that established an agreement between pharmacists and intensivists (critical care physicians) which provided the requisite order for billing MTM services on all patients managed by an intensivist.
The demand for pharmacy services and the number of billable MTMs both increased as evidenced by data collected for the residency project. Data was collected over a three month period at baseline and another three month period for comparison after the protocol was implemented. During this time the number of MTMs rose from 140 to 250 and the amount billed increased from $9,065 to $21,369 which were both statistically significant outcomes. Additionally, the MTMs billed at Level 0 and Level 1 decreased, and the number of services billed as Level 2 – 5 all increased, representing a shift toward more in-depth clinical consults and patient care. It is also noteworthy to mention that there were no Level 5 (highly complex) consults billed prior to the protocol and seven were billed during the study period.
And of course in addition to revenue, there is an improvement in quality.

13. We have been tracking the MTM program for several years.
From 2009 to 2014 we have seen significant growth in the number of clinical services eligible for MTM for a variety of reasons.
The clinical program has expanded to include more services
We increased the number of unit based pharmacists from 4 to 8
We increased the time available to conduct clinical services through CPOE impelentation in 2012.
The MTM program billed for 5,020 consults in 2012.
We billed for approximately 7,500 consults in 2013, and anticipate based on data extrapoloation, over 8,000 MTMs will be billed in 2014.

14. You may be wondering if there are cost savings and revenue statistics to support FTEs?
All MTM services are billed, however due to the DRG system and lack of provider status, Medicaid and Medicare do not reimburse for inpatient pharmacy cognitive services. Some insurance companies still reimburse at a negotiated percentage rate.
Thus, financial return is the relationship between private insurance predominance and negotiated rates. For example, an average hospital with 25% insurance paid care and 80% negotiated rates, return would be ~20% of charges billed.
Our program billed approximately 8,000 MTM consults in 2014 valued at over $1.5 M net patient service revenue.
80% negotiated rates for 25% of the population would be $1.5M x 0.2 x 0.8 = ~$0.3 M increased revenue to the organization. All for billing for work that was already being done!
This program has resulted in financial gain for the institution through payment from insurers for the billed services. Our system set it up so that the pharmacy department receives a credit as “pharmacy revenue” on the monthly responsibility report. This initially was approximately 50 cents on the dollar, but due to reimbursement changes is currently 35 cents on the dollar. Historically, this amount has ranged from approximately $35,000 to $55,000 monthly.

15. Before the MTM program started most progress notes written by pharmacists were limited to a few lines in the chart. Pharmacists were required to contact a provider when they determined that a change in drug therapy was warranted, and were only given the authority to change drug therapy and order labs when a physician specifically ordered “pharmacy to dose” on an individual patient.
The program began in this setting and the MTM program became the framework for the development of new clinical services and protocols.
The MTM program resulted in expansion of the pharmacy’s practice model. This required collaboration between pharmacy leadership and various physician groups. For example, developing the warfarin protocol involved several meetings with the cardiologists and revisions to the protocol.
MTM services now include protocols for pharmacist-management of warfarin, vancomycin, and aminoglycosides, renal dosing, and IV to PO conversions. Newer projects include programs to reduce readmission for pneumonia and heart failure which also fall under the MTM service. Pharmacists actively participate in the institution’s antimicrobial stewardship program. Patient education services have grown as education consults are included in dosing protocols.
In a few short years, our clinical program has tripled in number of services offered.
In this health system more patients have face-to-face contact with a pharmacist due to the MTM program than they ever did before. Pharmacist care is also more visible to the medical staff and other health care professionals because full notes are readily available in the patient’s electronic medical record.
The information gathered during patient visits has increased the quality of care. Pharmacists now catch and correct potential errors due to speaking with the patient as patients frequently offer new and relevant information during the interview that was not already in the medical record.
Additionally, pharmacists collect important physical information during visits. For example, some pharmacists have picked up on incorrectly recorded patient weights by simply noticing the size of the patient.
In addition to the obvious financial gain that has occurred from a program like this, the pharmacy department takes pride in the expansion of patient care opportunities. Any pharmacy management of therapy that starts with a physician order whether patient specific or per protocol can be carried out as an MTM and billed
Pharmacists now have more autonomy. Pharmacists are managing more therapies without input from physicians. This is in comparison to 2007 when pharmacists primarily made recommendations for therapy changes.

16. Hurdles Laws, Rules, and CMS Resistance to Change Perceptions
Billing issues
Administrative Support
Resources
There are some hurdles that need to be address to ensure success of the program.
For example each state will have differing laws, rules, and regulations regarding the implementation of MTM.
In this state, the Board of Pharmacy requires documentation of the MTM service in the medical record, and specifically requires the inclusion of a note written in SOAP format, and because we do not differentiate who CMS requires a face-to-face visit with the patient for each consultation.
There may be some resistance to change:
At our institution there was resistance to change and many pharmacists voiced concerns about the additional time it would take to interview the patient and complete the appropriate documentation. To address this concern, a process of change management was used. The program was rolled out in stages and covered only a few clinical services in the beginning. Billing began in February 2008 with a rough start as some pharmacists struggled to meet the requirement of speaking with each patient. Pharmacists were provided with training on how to conduct a short and effective interview, and technology and sharing of ideas also helped ease the transition. Many pharmacists created electronic progress note templates and shared them with the rest of the staff to decrease the time needed to complete documentation. The informatics pharmacist was utilized to built reports that assisted pharmacists in prioritizing consults and streamlined the process of gathering pertinent patient information.
Perceptions:
There was the initial assumption amongst staff of a lack of pharmacy staff resources to complete MTMs, but out of the success of the program came support for additional pharmacist shifts dedicated to drug therapy management. Before the department had an MTM program there were four unit based pharmacist (UBP) shifts that were responsible for drug therapy management. There are now eight UBP shifts. The additional time was gained by two mechanisms: pharmacist time shifted away from order entry with the implementation of an EMR, and approval of additional FTEs by hospital administration for increased pharmacy services. Our new staffing model provides coverage in more patient care areas with increased clinical coverage into the evening and on weekends, and allows for a lower pharmacist to patient ratio.
Billing Issues
It required some work with the finance department to initially establish a complexity rating system and billing values. Finance has to benchmark billing practices for pharmacy services based on other clinical therapeutic services, such as dietician, physical therapist, and respiratory therapist.
Hospital administrators are in support of the pharmacy program and see the importance of submitting a bill even if payment is not always expected as this billing data is another way of documenting the value of care provided by pharmacists.
There are no additional qualifications required of the pharmacists who provide MTM services.
Additional resources included, roughly 5 minutes of pharmacist’s time per patient encounter, time spent by a charge Capture Specialist (reportedly is only minutes per bill). Reports needed to be developed to assist the charge capture specialist in collecting all potentially eligible pharmacy services. And some management time to perform spot check audits, and provide pharmacists feedback.

17. Expectations for Short and Long Terms
Short Term
Long Term
Increased Net Patient Service Revenue
Improved Patient Care
Increased Visibility
Employee Engagement
Expanded Role
Alignment of the Program with Organizational Goals
Readmission Reduction
Antimicrobial Stewardship
Expansion
Outpatient Services
Increase Inpatient Services
Provider Status
Financial Game Changer
Outcomes
The purpose of the MTM program has been fulfilled by increasing revenue for the hospital and improving patient care.
The goals of impacting patient care have also been met. Pharmacists have increased appropriate medication use by providing patient education on high-risk medications like warfarin and have increased the amount of pharmacist-managed consults through the development of protocols that add more clinical services to the MTM program.
Because providers are now more aware of pharmacy service, the opportunity for pharmacists to manage TPNs came when the health system converted to an electronic medical record.
Pharmacists are making an impact on preventing adverse drug events as they are required to assess for drug interactions and response to therapy during warfarin consultations.
This hospital has a student program with about 50 clinical rotations offered each academic year and an ASHP-accredited PGY-1 residency program with four residents. Students and residents enjoy working in the MTM program and report that other institutions are not conducting inpatient MTM services. Many students look forward to their clinical rotations in a hospital setting but assume they will have limited patient interaction due to what they were taught or have experienced. They are pleasantly surprised when they find out that interacting directly with patients happens on a regular basis throughout the day. This exposure during experiential education prepares them for an expanded role in drug therapy management in hospitals and health systems. (The consensus of the Pharmacy Practice Model Summit, 2011)
The program has overtime, increased the number of clinical programs that align with the organization’s goals, such as reducing readmission and improving antimicrobial stewardship.
We have expanded the MTM program in our 125 bed hospital last year. We recently merged with a 49 bed hospital, and our hope is to implement the MTM program by April, 2015.
The future looks bright as pharmacists are trying to implement MTM services in an outpatient infusion center operated by the hospital. Although this is not an inpatient setting, MTM has been slow to begin here as the pharmacy operates under the framework of a nurse-run clinic. Successes with the inpatient program have driven the desire to add MTM services for this patient population. Care can be greatly impacted by pharmacists providing drug therapy management and performing MTM keeps many pharmacists engaged and feeling like they are making a difference.
If and when Pharmacists’ provider status legislation HB 4190 passes, and pharmacists are included in title XVIII of the Social Security Act to provide coverage under the Medicare program, this may provide a mechanism for pharmacists to be reimbursed by the Medicare program for cognitive services, in certain underserved areas. We still don’t know how this will pan out at the state level, but it may be a financial game changer.

18. Summary – Key Points
Regulations
Coding
Train
Capture
In summary, the implementation of this program was truly innovative as pharmacy leadership looked for a way to heighten pharmacy services and bring in revenue for cognitive services. During development of the program there were no examples found of other institutions pursuing billing for inpatient MTM.
In 2014 members of the pharmacy staff and management began discussing the MTM program with others outside the health system. So far they have not come across someone with knowledge of billing for inpatient MTM services at another institution.
A search of the literature revealed one program that uses pharmacists for a continuity of care program. Patients are referred for MTM services but this is performed after discharge and there was no reference to billing. (Reference article)
As members of the pharmacy management team have been sharing the successes of the MTM program with colleagues there has been intense interest from other hospitals in the state and throughout the nation.
This program elevates pharmacy services and increases awareness of pharmacy practice to the patient and their family and other healthcare practitioners, insurers, and health system administrators. Pharmacists have also been inspired to expand these services whenever possible by getting a physician order for things like medication histories and polypharmacy consults so the service can be formally documented and billed as MTM.
The unique and innovative program has definitely “raised the bar” in the pharmacy department by providing a framework for increasing the number of pharmacist-managed programs and bringing unclaimed revenue into the institution. Pharmacists are now more visible in daily interactions with patients and providers and have taken on greater responsibilities in patient care.
Many recommendations from the Pharmacy Practice Model Summit have been achieved through development and implementation of the inpatient MTM service.

19. Are there any questions?
If you would like more information my contact information is at the bottom of the handout