MTM Outcomes: A Comprehensive Guide to Medication Therapy Management

Medication therapy management (MTM) is a program that can help ensure patients receive the most appropriate medications and allows pharmacists to efficiently monitor a patient’s progress and optimize health outcomes. Learn more about how MTM can improve patient outcomes while making medication management easier for providers. 

What Is Medication Therapy Management?

Medication therapy management (MTM) refers to a range of services provided to patients that can help improve the benefits they receive from their medications while preventing and resolving medication errors. 

It is a helpful service that enables pharmacists to  review all patient medications — even from numerous prescribers, including over-the-counter and herbal medications – and optimize treatment regimens to maximize outcomes. Common problems medication therapy management can prevent and resolve include:

  • Improper medication use
  • Drug interactions
  • Medication duplication
  • Unnecessary medications
  • Polypharmacy
  • Need for medications for untreated conditions 

Medication therapy management also offers medication education, consultation, and advice to patients, caregivers, and families to assist in the proper use of medications. Thus, it allows maximum collaboration between patients and providers. 

By making patients active participants in their care and encouraging them to be more knowledgeable about their health, MTM healthcare helps foster a more positive partnership between them and their health providers. 

What is an MTM pharmacy? It is a pharmacy that offers MTM services for eligible patients.  

In short, MTM focuses on the ongoing management of a patient’s entire medication regimen while simultaneously focusing on optimizing effectiveness and preventing adverse side effects. 

How Patients Pay for MTM Therapy

MTM reimbursement for patients on Medicare can occur when pharmacies directly bill the medical benefit using medication therapy management CPT codes or work with a third-party service contracted by the insurance company to facilitate an MTM program. 

Medicare requires an annual comprehensive medication review (CMR) focused on chronic conditions for eligible patients.  Many Medicaid and commercial plans have also adopted MTM as a covered benefit.When using an MTM outcomes platform, pharmacists can employ three CPT codes for billing, depending on whether the visit lasted 30 or 15 minutes. To do this, pharmacists must be enrolled in a plan’s provider network with a National Provider Identifier (NPI) number. 

MTM services cannot be provided free of charge or at a reduced rate for certain patients if you are billing a plan for MTM that you provided for other patients. Some payers also require pharmacists to use a particular documentation system to bill for MTM, and they may need you to show evidence that you have training in using that system. 

For patients with Medicaid plans, check to see if you can rely on the same MTM platform you use for Medicare. Not all plans offer this option. Each payer will have its own criteria for MTM patient eligibility. Identify the requirements or ask for a list from the payer of the eligible patients. 

You will need to contact private payers directly to inquire about specific details. For instance, you should ask about their coverage of MTM, what codes you should use when billing, the exact steps you need to take, and what MTM reimbursement rates to expect. 

MTM Outcomes

MTM can offer benefits for both patients and providers. However, some challenges still need to be resolved. 

Benefits of Medication Therapy Management 

MTM can lower costs because it can help find the right medications while eliminating unnecessary ones. It can also help prevent complications from incompatible medications that might make further treatment necessary. 

MTM has the potential to promote medication adherence by allowing pharmacists and other healthcare providers to check that each patient follows their drug therapy regimen and that there are no gaps in treatment. 

The medication assessments that MTM services encompass can aid pharmacists in determining whether the medication is the most appropriate for the patient. They do this by considering the patient’s health challenges and monitoring results. 

Patients can also participate in collaborative care. In turn, they can feel more in control of their care and more informed about their decisions. 

MTM Challenges 

Implementing MTM services can take time and effort from pharmacists, making it a challenge for smaller community providers. Staffing limitations and the need for training can be a concern. There is also a lack of managerial support from pharmacy owners or corporate entities, leading to difficulties in implementing MTM services. 

Changes in technology pose an additional concern. Having access to medical records is essential for MTM services, but it is not easy to integrate community pharmacies into the technology network. 

Some companies have even restricted the use of web-based vendors for MTM, which creates further challenges because MTM vendors tend to rely on web-based software for billing and documentation. Having to use many platforms simultaneously makes the process more complex than it needs to be. 

Reimbursement can also be challenging outside of Medicare plans. Even if the payer offers reimbursement, compensation rates are often low. In addition, the pharmacy — not the pharmacist — receives reimbursements, creating ambiguity. 

Patient participation is another potential concern. Patients are generally unfamiliar with MTM and worry about added costs while not recognizing that pharmacists are more than dispensers of medications. They may also be unaware that pharmacists collaborate with their physicians to help make medication recommendations. 

Implement MTM with DocStation

DocStation helps pharmacists claim provider status and get paid for services.  The DocStation platform offers electronic health records that allow you to maintain a comprehensive record of all the medications your patients receive and other important health information through claims integration with payers dispensing systems integration with your pharmacy management system.

DocStation enables pharmacies to easily provide, document, and bill for MTM services directly to the medical benefit using CPT billing codes. This provides enhanced reimbursement rates compared to other 3rd-party MTM outcomes platforms, and enables pharmacies to bill any and all payers for these services, expanding the financial opportunity to your entire patient base. It offers revenue cycle management services that tell you where your claims are in the billing process, helping you quickly manage claim issues and denials. 

DocStation also helps MTM pharmacists participate in payer-sponsored MTM programs, letting you use one platform for everything. DocStation provides integration to reduce the administrative burdens that other medication therapy management services may not address. It is not a one-size-fits-all platform, but it can run value-based and MTM programs at the same time. 

To streamline the entire medication management pharmacy process and gain all of the benefits that MTM offers, reach out to DocStation today.