Search

Objective: To assess the adoption of the Minnesota Department of Human Services (DHS) medication therapy management (MTM) program by patients and pharmacists., Design: Descriptive nonexperimental study., Setting: Minnesota DHS MTM program, from 2006 to 2011., Main Outcome Measures: Number of claims, providers, and dollars compensated each year from 2006 to 2011, as well as location of claim submissions and percent of eligible patients served in 2011., Results: During 2011, 76 pharmacists were compensated a total of $210,716 for 2,427 claims. Of these claims, 1,009 were initial visits and 1,418 were follow-up visits. In each of the first 6 years of the program, an increase was seen in number of claims, number of pharmacists submitting claims, and dollars compensated. These increases followed exponential curves for total number of claims and dollars compensated with a declining logarithmic curve for pharmacists. From 2010 to 2011, the number of claims and dollars compensated did not increase as much from 2009 to 2010. However, claims data may still increase for 2011 as a result of late submissions. During 2011, the percentage of eligible patients provided services was estimated to be 5.7% to 7.6%., Conclusion: The continued increase in use indicates that the program has had a successful beginning and promises to serve many more patients. The small percentage of patients reached should increase with subsequent years. Better strategies to recruit patients and pharmacist providers should increase use of the program.

Objectives: To inform medication therapy management (MTM) providers of findings of the Minnesota Department of Human Services review of claims submitted to Minnesota Health Care Programs (MHCP) for patients receiving MTM services and to discuss the impact of the audit on widespread MTM services and future audits., Methods: A retrospective review was completed on MTM claims submitted to MHCP from 2008 to 2010. The auditor verified that the Current Procedural Terminology codes billed matched the actual number of medications, conditions, and drug therapy problems assessed during an encounter., Results: 190 claims were reviewed for 57 distinct pharmacies that billed for MTM services from 2008 to 2010, representing 4.5% of all claims submitted. The auditor reported that generally, the documentation within the electronic medical record had the least "up-coding" of all documentation systems. A total of 18 claims were coded at a higher level than appropriate, but only 10 notices were sent out to recover money because the others did not meet the minimum $50 threshold., Conclusion: The auditor expressed concerns that a number of claims billed at the highest complexity level were only 15 minutes long. Providers will need to be cautious of the conditions that they bill as complex and of how they define drug therapy problems. Everything for which is being billed must be clearly assessed or rationalized in the documentation note. The auditor expressed that overall, documentation was well done; however, many MTM providers are now asking how to internally prepare for future audits.