- Why do I need to use the Cyber Access tool to perform MTM services for patients with active encounters?
Providers do not have to utilize DCPro to perform MTM services. Other than to get dates of services, billing information, other stuff. When a participant meets specific disease-based criteria, a pharmacist may provide or cause to be provided, as allowed by the MBOP, a wide variety of MTM services to address specific treatment needs. Providers may utilize eMOMED or their billing software to bill for MTM services. Providers must use the proper codes and the number of units when submitting the claim.
- How frequently may I perform MTM services for illedgable MO HealthNet patients that do not show active encounters in Cyber Access? Would it be monthly if needed?
Participants are limited to four (4) total MTM units per rolling month per provider.
- May I use encounter forms (i.e. SF 8, Hypertension, Diabetes) labeled "Conduent Question and Answer" for MTM services not performed within the Cyber Access environment?
Pharmacists typically record patients' medical records for MTM securely and confidentially. The exact process and location for recording these records may vary depending on the pharmacy setting and available tools. Here are some standard methods:
- Electronic Health Record (EHR) Systems: Many pharmacies use electronic systems to manage patient records. Pharmacists can record MTM-related information directly into the patient's electronic record, including medication lists, medical history, allergies, and relevant clinical information.
- Pharmacy Software: Pharmacies often have specialized pharmacy management software that allows pharmacists to document and access patient records. These systems may have specific modules or sections dedicated to MTM documentation.
- MTM Software Platforms: Some pharmacies use dedicated MTM software platforms designed to support the MTM process. These platforms offer features to document medication-related assessments, interventions, and outcomes.
- Paper-Based Records: Sometimes, pharmacies may still rely on paper-based records. Pharmacists can document MTM-related information in a designated patient file or form securely stored in the pharmacy. Follow your organization's policies and procedures regarding MTM documentation to ensure compliance and maintain accurate patient records.
- How do we bill for MTM?
MTM services can be billed through DCPro, eMOMED, or billing software.
- What is a professional dispensing fee? How do we bill for it?
MTM and PPS do not receive a professional dispensing fee as these services are not billed through the pharmacy’s point of sale system.
- What are other services that a pharmacy can bill for, in addition to MTMs?
PPS services that fall within the scope of
practice as defined by the Missouri Board of Pharmacy outside of the dispensing
of medication to participants. PPS services can be provided to Fee For Service
(FFS) participants only.- Can we bill consecutive 15 min increments for one 60 min session?
Yes, after the initial 99605 or 99606, the 99607 can be billed for each additional 15 minutes.
Please see chart in the Pharmacy Provider Manual for more information.
- How do we get a signature if additional MTM sessions are via Zoom, phone, or
other virtual setting? The participant’s signature is required after each MTM encounter; an electronic signature is acceptable.
- Who can bill for MTM services?
The encounter can be performed in the
pharmacy or by the pharmacist in Federally Qualified Health Center (FQHC or clinic.- Can MTM services be provided to participants in a facility or while in-patient?
No, participants residing in a setting where an individual needs medical or long term care (LTC) services are not eligible for MTM services.
- What services can be billed for in this?
PPS services that fall within the scope of practice as defined by the Missouri Board of
Pharmacy outside of the dispensing of medication to participants. PPS services
can be provided to Fee For Service (FFS) participants only.- What is the reimbursement provided for PPS claims?
The reimbursement is based on the Current Procedural Terminology (CPT) code of the service that is provided. The reimbursement for the CPT code can be found on the Fee Schedule under medical services.
- What is the required setting?
The encounter can be performed in the pharmacy or by the pharmacist in Federally Qualified Health Center (FQHC) or clinic.