Billing for MTM Services in Minnesota

Course Overview

This five-part online course provides foundational knowledge for understanding the overall fee-for-service billing landscape for medication therapy management, also called comprehensive medication management, in Minnesota. It also provides the basics on contracting, provider enrollment and credentialing, service expectations, and claim reconciliation in addition to providing an understanding of the support structures needed to bill for services. 

The materials for this course are hosted in Canvas, the University's learning management system, which requires a University of Minnesota account to access. If you have an existing UMN account, you can register for this course using that account; otherwise, you will be directed to create a University of Minnesota Guest Account during registration.

Target Audience

This program is designed for pharmacists who provide MTM services in Minnesota and have the need to be reimbursed through Medicare. 

Learning Objectives

  • Describe payers in Minnesota reimbursing for MTM using fee-for-service mechanisms.
  • Compare the different billing mechanisms that exist, including MTM CPT codes, incident to billing and Medicare Part D
  • Discuss the contracting process in relation to billing and payer credentialing
  • Outline various components of a contract and the considerations needed for each
  • Discuss Enrollment and Credentialing Processes necessary for billing MTM Services.
  • Provide tools for practitioner enrollment  in DHS and PMAP plans.
  • Describe key factors in creating necessary infrastructure to send claims and receive reimbursement for services
  • Evaluate participation in MTM networks specific for your clinical site
  • Review the life cycle of a claim
  • Discuss specific billing requirements for Minnesota Medicaid plans
  • Review how to determine the status of a claim

Instructors

Amanda Brummel, PharmD BCACP
Vice President, Clinical Ambulatory Services 
 
Amanda Brummel, PharmD, BCACP serves as the Vice President of Clinical Ambulatory Pharmacy Services. Dr. Brummel has been employed by Fairview Pharmacy Services since 1999 when she graduated from the University of Minnesota.  While at Fairview, she has built and practiced Medication Therapy Management (MTM) in multiple clinic locations, was the clinical supervisor for the MTM department, the MTM Operations & Program Manager. Currently Dr. Brummel has responsibility for the MTM program, the clinical development and integration of pharmacy services in the Fairview Health Network including our transitions of care approach and our retail clinical services. She works closely with the Fairview Medical Group and the Fairview Network in our population health approach and new payer product development. Dr. Brummel is also an Adjunct Associate Professor at the University of MN. She has published multiple articles on MTM and pharmacy’s role in the care team.   
 
Beth Clarine
MTM Coordinator
Fairview Pharmacy Services
 
Beth became a CPhT in November of 2012 which lead her to join the Medication Therapy Management team in August of 2013. Since then she has been responsible for the Credentialing and Enrollment of all of the Medication Therapy Management Pharmacists for Fairview and HealthEast. Beth also work with the MTM claim reconciliation and billing process for Fairview and HealthEast.
 
Sarah Westberg , FCCP, BCPS

Schedule

Billing for MTM Services is a fully online, self-paced course that covers a range of topics and concludes with a cumulative quiz. This course includes five modules. Each module contains a video presentation to help you master these topics and prepare for the final assessment. Participants will be required to pass the 11-question quiz with a score of 70% or better. The learning materials and assessment will be available online 24/7. 

 

Module 1

Overall Landscape of Payment for MTM Services in Minnesota

Module 2

Contracting

Module 3

Provider Enrollment and Credentialing

Module 4

Implementation of Billing for MTM Services

Module 5

Claim Reconciliation Process for Documentation and Billing

Accreditation

Accreditation logoIn support of improving patient care, University of Minnesota, Interprofessional Continuing Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.

This knowledge-based online educational offering has been approved for 2 contact hours. The Universal Activity Number is JA0000810-0000-19-088-H04-P.

Following successful completion of the online activity and an activity evaluation, participant data will be submitted to The Monitor within 10 days. 

 

CE completion requirements
  • CE participants must be pharmacists.
  • Participants must complete the online activity, passing a cumulative quiz (70% or better).
  • Following successful completion of the above activity requirements as well as submission of a course evaluation and verification of completion form, participants will be able to access their CPE data directly from the Monitor. Once information is received by NABP, the tracking system will make CPE data for each participant available to the state boards of pharmacy where the participant is licensed or registered. 

Registration

Text and DORS link