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  • Title: Current trends in outpatient pharmacy services and billing.
    Author: Beatty SJ, McCormick KM, Beale DJ, Bruggeman AM, Rodis JL, Mehta BH, Bennett MS.
    Journal: J Am Pharm Assoc (2003); 2012; 52(2):154-60. PubMed ID: 22370377.
    Abstract:
    OBJECTIVES: To provide a summary of community and ambulatory pharmacy practices and billing patterns for medication therapy management (MTM) services and to identify reasons pharmacists report not billing for direct patient care services. DESIGN: Cross-sectional study. SETTING: United States, February 2011. PARTICIPANTS: Members of the American College of Clinical Pharmacy Ambulatory Care Practice and Research Network, American Society of Health-System Pharmacists Ambulatory and Chronic Care Practitioners, and American Pharmacists Association MTM e-community. INTERVENTION: Online survey. MAIN OUTCOME MEASURES: Practice setting, pharmacy services performed, billing technique, and payer, as well as reasons for not billing. RESULTS: MTM services were provided by 287 pharmacists. The most common practice settings included physician office (23.6%), health-system outpatient facility (21.7%), and community pharmacy (20.2%). A total of 149 of 276 pharmacists (54.0%) reported billing for MTM services; 16 of 276 (5.8%) did not know if they were currently billing. Community pharmacists were more likely to bill than all other sites combined (80.5% vs. 53.1%, P < 0.001), and pharmacists with >75% of visits face-to-face were more likely to bill (66.2% vs. 46.6%, P < 0.002). CONCLUSION: A variety of MTM services are provided in outpatient settings with inconsistent billing techniques and reimbursement. Pharmacists should continue to work toward consistent, sustainable reimbursement to expand MTM services.
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