Pharmacy FAQ for CMTM 07-18-06 What is Community MTM (CMTM)? Community MTM is a Web-based communications service that allows pharmacists to conduct, document, and bill for a variety of sponsors patient care programs including medication therapy management. I want to participate in the CMTM pharmacy network. How do I get started? You will need to sign a service agreement to join the CMTM pharmacy network. This document is available at www.communitymtm.com. Click on the Join Our Network link from the homepage. There is no charge to the pharmacy to join the CMTM network, and this will enable your store to participate in any of our sponsors programs running on the CMTM platform. Remember you must agree to the terms and conditions before you can proceed. If you are part of a chain, buying group, or 3 rd party contracting entity, please check with their representative to determine if they have contracted with CMTM on your behalf. How will I be trained on CMTM? CMTM facilitates just in time training coincidental with receiving your first patient. Training will consist of live web-based training, self-paced web-based training, and printable user guides. These training materials are located at http://www.communitymtm.com/training.html Do I need to download any software? No, CMTM is a Web-based application. After you sign the online contract, a representative from CMTM will contact you to verify your information and give you your username and password. To access the CMTM application, go to the Web address (URL) the representative gives you and type in your username and password. Do I have to figure out which patients meet the criteria for services? No. The CMTM communications service will deliver the patients to you. When you log into the CMTM Web-based service, you can see if there are any patients in your assigned cases queue. Why are there less patients assigned than I was told were eligible?
You will be assigned up to 10 patients at a time. CMTM will replenish your assigned patients queue as you complete cases. How long will a typical MTM session last? A typical MTM session is expected to last about 30 minutes. Other types of patient care services can vary in duration. Will I be paid for MTM services? How much? Each type of billable patient care service is priced by the plan sponsor. You will have the option to participate with all or some of the programs. It s your choice. For example, the CCRx Medication Therapy Management program is a billable patient care service. The reimbursement rate is $60 (geographically adjusted) for a 30-minute session. I just conducted an MTM session that took longer than 30 minutes. Can I bill for the extra time? No. MTM sessions should average 30 minutes and are reimbursed at $60 (geographically adjusted). Can the CMTM system track billing and reconcile payments. No, at this time the CMTM system cannot track billing and reconcile payments. Can the CMTM system be integrated with my dispensing system? No, at this time the CMTM system cannot be integrated with any dispensing systems. How much time do I have to schedule an appointment with a patient once I see it delivered to my assigned patients queue? The patient should be contacted within three days. How much will the patient have to pay for this service? The CCRx MTM once annual session with the patient s pharmacist is a covered benefit for qualifying patients. It is free of charge. I don t have Internet access in my pharmacy. Can I still participate?
You must have Internet access in order to use the CMTM communications service. It doesn t matter where that computer is located. You can print out a hard copy of the information for the MTM encounter and enter the data into CMTM at a later time. I have patients in an assisted living facility. How can I conduct their MTM session if they are qualified? If the assisted living facility doesn t have Internet access, you can print out a hard copy to conduct the session, and enter the data into CMTM at a later time. How do I bill for an MTM session or other patient care service? The CMTM communications service has a billing function built into the application. You will not need to enter CPT codes. Just click on the submit key from the billing screen, and your claim is on its way for processing and payment. How often will I be paid? Payment for MTM services will be made within 60 days of close of the calendar month in which charges are submitted and will be made by CMTM on behalf of the CCRx MTM program. The payment will be separate from dispensing services. I don t have time to enter data into CMTM. Can my tech handle the data entry? Yes, you can allow your technician or any other appropriate individual, consistent with the privacy practices of the pharmacy, to enter the data into CMTM. The pharmacist providing the MTM service should be designated as the provider. Once the encounter is billed, the electronic record is frozen. You may want to review the data for accuracy prior to submission. Is CMTM HIPAA compliant? Yes, the CMTM communications service encrypts the data during transmission and is fully HIPAA compliant. I need help with using CMTM. Can you assist me? CMTM features a built in help module in the application in addition to online WebEx sessions. If you need to speak with someone for assistance in using the application, please call 520-626-2777 Monday through Friday from 7 a.m.-6 p.m. Arizona time. Leave a message, and your call will be returned within two hours. Are there materials available that can help me provide the MTM service?
There are materials available for download with the CMTM communications service, including an encounter guide that instructs the pharmacist how to conduct an MTM session and patient education materials about specific conditions to give to your patient during the visit. What if I sign up as a participating pharmacy but no patients are assigned to me? It is possible that none of your patients will qualify for MTM, however, CCRx is implementing other patient care services such as the Welcome to CCRx Medication Review, which will be available to all new members after June 1, which gives you other opportunities to provide patient care services through CCRx utilizing the CMTM communications service. As more plans and sponsors put their programs on CMTM, your opportunities to provide billable patient care services will increase. My payment for services rendered hasn t arrived. Where is it? Please call 520-626-2777 with any billing questions. Payment for services rendered should arrive within 60 days of claim submission. CCRx-Centered Questions How often can my patient receive a CCRx MTM session? Qualifying CCRx patients receive one MTM session per benefit year. I am a LTC pharmacy. Can I participate in the CCRx MTM program? At this time, the CCRx MTM program is only available to retail pharmacies. We are working to establish an MTM program for LTC patients. MTM for LTC patients is expected to be different as LTC patients already receive a medication review by a consultant pharmacist. I have an MTM patient in my assigned cases cue. What should I say to a patient who qualifies for MTM in order to get him/her scheduled? Let your patient know he/she is being contacted because through CCRx he/she is eligible to receive an MTM session with you. Tell your patient that the purpose of the visit is to help him/her know more about his/her medication regimen and that you may be able to provide advice on how to save money on prescription drug costs. Inform your patient that this service is free of charge to the patient, and participation is voluntary. What if my patient doesn t want the service?
Participation in the CCRx MTM program is voluntary. If your patient declines the service, record the declination of service and the reason why (select a choice from the pull-down menu on the page) in CMTM and submit the bill for payment. CCRx will pay you $5 if you contact the patient, and the patient declines the service. What if a patient doesn t qualify but wants to pay cash? That would be between you and the patient if you want to conduct an MTM session for a patient who doesn t meet the CCRx MTM criteria. You would need to collect the payment directly from your patient. At this time there is no method to capture and record the data in CMTM. Will it cost me anything to participate? No, pharmacy participation in the CCRx MTM program is voluntary and free of charge. I don t want to participate. What will you do with my patients who qualify for MTM? If you are not a participating pharmacy, patients who would normally be assigned to your store will receive their MTM services by phone with a pharmacist from the University of Arizona College of Pharmacy. They will work with the patient s physician if any medication changes are needed and send you a follow-up report of the encounter. What is the difference between MTM and the Welcome to CCRx Medication Review? Medication Therapy Management also referred to as MTM is a service given to people to help them use their medications correctly and to provide health information that can help them with their prescription drug treatment. With CCRx every patient who qualifies for MTM will have the opportunity to have the session conducted face-to-face with his/her community pharmacist. The goal of the MTM session is to ensure optimum therapeutic outcomes for targeted beneficiaries through improved medication use. The Welcome to CCRx Medication Review is a new program developed to help new members and improve their transition into CCRx. The outcome elevates the quality of care to beneficiaries through face-to-face encounters with their community pharmacists for a timely review of their drug regimens as they transition into Medicare Part D. During the Welcome to CCRx Medication Review community pharmacists will be expected to: Review the patient s medications to educate the patient and/or intervene as clinically appropriate.
Compare the medications currently taken by the patient with the CCRx formulary and identify cost-saving opportunities for therapeutic and/or generic substitutions. Document the nature of the services they have provided to the patient. How will I be assigned a Welcome to CCRx Medication Review? The Welcome to CCRx Medication Review is available to all CCRx beneficiaries who enrolled after June 2006 and have benefit effective dates after July 1, 2006. This service is voluntary and is requested by the beneficiary. If a beneficiary elects to participate in the Welcome Review, he/she will call a dedicated number to request the service and inform the representative which pharmacy the beneficiary uses. CMTM will load the case into your assigned patients queue.