Tuesday, January 25, 2011

Getting paid for MTM services

Getting paid for MTM services.....page 42. That was on the cover of the most recent Pharmacy Today. When I saw that, I heard the angels singing.

Finally, an article about getting reimbursed for medication therapy management services. Perhaps some insight in how to sign up as a provider with a medical insurance company. Personally, I've been trying to get contracted with the major insurers in my area for over a year with little success.

This article could be the holy grail for those of us who want to attempt to provide MTM services as a stand-alone business. Finally something from the APhA that tells us how to make some money, rather than just telling us that our services are valuable and save the health care system in the long run.

I sat down to read the article during my lunch hour, legal pad at my side to jot down notes. I had been looking forward to reading this since I received the Pharmacy Today issue in my mailbox a couple days ago.

After reading the article I can tell you this... don't bother reading it.

Not a darn thing.

False advertising.


pharmacy chick said...

Honestly Eric, there isn't much in pharmacy today..its like the People mag of pharmacy. I know how much MTM means to you so I hope that one of these days, this "holy grail" will come to you.

Frantic Pharmacist said...

I am forever disappointed in those magazines. Biggest waste of paper ever. The titles always look promising -- and it ends there.

bulldog said...

we do mtm almost daily in my store using outcomes, and are paid well. Problem with doing it as a stand alone is just not enough hours in the day. Also, in our state you must do the full mtm (may be done once a year/patient) for $50, then follow up to see what changes you recommended have been ok'd by dr, these interventions can then be billed seperately, and then we can bill any subsequent recommendations, changes, interventions etc, usually these are simple/basic and we are paid $10 per, so you gotta be in a pharmacy to see patient regularly to bill for all your advice. No really possible from behind a desk but we do it daily, billed abt $200 yesterday, 150 day before, it works for us. If you are curious, want to discuss it let me know.

Anonymous said...

IANARPh and I'd gladly pay for this, especially since my insurance company's generic copays are so ludicrously high that I have rxs filled at 3 different pharmacies (and mail in the couple that are cheaper going through the PBM). I used to be able to get 90 day fills at my local pharmacy, and I miss the comfort level of having pharmacists I know look out for me. I would pay cash for this service

Eric Durbin, RPh said...

Anon from 2-15 @ 6:07

Shoot me an email and I'll send you a link to connect you to a pharmacist who can help you.

If you are from Ohio, I'll take care of you myself.

Kristine Ashcraft said...

I work at Genelex - we are a leading provider of pharmacogenetic testing services and even provide interpretive software that shows the impact of all the meds and genes on AUC so dose or drug adjustments can be made. The problem - most docs don't have a clue or don't have the time. We have patients willing to pay cash for consults as well. If any pharmacists are trained or willing to learn to help with this, I'd love to talk to them.

Anonymous said...

And that is why I am no longer an APhA member. Waste of money with no return on investment!!!

Anonymous said...

Eric, if you have insight on billing for MTMs (especially in California), I'd like to pick your brain. I'm already using Outcomes but they only work with Humana and that REALLY limits my ability to use their program. I'm also going to attend an APhA certificate program in hopes it will help me in the MTM arena. Any help you could give in regards to billing would be fabulous. Thank you!

Dave said...

I am in NY and looking to try and do this pretty much as a stand alone service. But I will be within a nursing agency. Technically, being there could provide a stream of clients. What I am looking to find out is who deals with Outcomes, Mirixa and PharmMD...overall how is the reimbursement? Is it just Medicare they deal with? I am not sure at this point that the service is viable on its own per unless like it was stated earlier...you are seeing a lot of patients.