"It's absolutely excellent! Did you decide to begin building a new career this year? Or finally start that business you've always wanted to? Or take that course you've been thinking about? For the past three years, I have been publishing articles about goal setting to kick off the new year. It has been a way to hold myself accountable, keep track of my successes (and failures), and because of it I believe I enjoy life more fully than some do in a lifetime and hopefully inspire others to do the same. Year after year, I stress the importance of creating goals for your life (personal relationships, financial, career and health/self-care). Goal setting has allowed me to step away from jobs I don't love, charge what I'm worth and take chances on new ventures. If we hadn't started setting some Family Financial Goals back in 2013, I don't think I would have as many opportunities and options as I do today. We'd still be "paying interest and not ATTENTION" in the words of Dave Ramsey. In fact, we've been using a combination of Mint, Betterment and the notepad app on my phone consistently since 2014 to successfully nearly double our SAVINGS AND EARNINGS rates. Some of those goals include:
Check out my 2016 Goals and my first year in Online Business here. Check out my 2017 Goals and my second year in Online Business here. Check out my 2018 Goals here. If you haven't yet, now is the time to start planning your Personal and Career Growth by setting your goals for 2019. I set Big Annual Goals in four areas of my life:
In our new Business Development Workshop I teach you my process for setting your Business/Career Goals and share my own 2019 Goals. Goal setting has allowed me to step away from jobs I don't love, charge what I'm worth and take chances on new ventures. Even though it wasn't on my "goal list" for 2018, I thought it would be fun...so I created a new Planner based on the CORE FOUR Elements of the Healthy Business Helix. The 2019 Business Development Planner, now available on Amazon, follows along with my latest Business Development Workshop: Planning for 2019 Like a Pharmapreneur. "You must plan ahead to achieve anything great. " This Business Development Workshop will introduce you to my Business Development Framework, designed to walk you through the Core Four Elements of Productive Planning to Achieve Your Career Goals. The Framework will walk you through the Core Four Elements of:
I love goal setting and I hope this Workshop will help you set some Personal, Career, Financial and FUN Goals for 2019! Click here to register for the free Planning for 2019 Like a Pharmapreneur Business Development Workshop. ABOUT THE AUTHOR: Blair Green Thielemier, PharmD is an independent consultant pharmacist living in Arkansas with her husband and two children. Her latest project is the host and producer of pharmacy’s first virtual conference, the Elevate Pharmacy Virtual Summit in partnership with the NCPA Innovation Center. She is the founder of Pharmapreneur Academy, an online e-Course and Community where she guides pharmacist-entrepreneurs through the process and barriers of building a pharmacy consulting business. She is the author of How to Build a Pharmacy Consulting Business and facilitates in-person Business Planning Workshops and Mastermind Retreats for female Pharmapreneurs across the country. More information about Dr. Thielemier can be found on her website.
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I haven't yet publicly shared the moment that caused me to begin looking into my own genetic variants, but I can tell you exactly when I had my "ah-ha moment".
December 28th, 2017 at 1:25pm My son was just born and the neonatologist was doing his assessment. Under the yellow light of the exam table, I noticed her looking closely at the base of his spine. I asked her if something was wrong. She said, "I'm looking to see if I can see the bottom of this hole, if I can't see the bottom we'll have to do an ultrasound." I told her that his sister had the same dimple and she was fine. This seemed to satisfy her. But when I looked at it, she was right, this was MUCH MORE than a dimple. You cannot easily see the bottom of the tiny hole at the base of my son's spine. The information about my daughter seemed to ease the neonatologists concerns, but it got me thinking...
So many things go through your head when you are caring for a newborn, but for me in the back of my mind I knew there was something I needed to look into further. I've been interested in Pharmacogenomic testing for the past few years, but I decided to start my precision medicine journey by testing myself. A few month after my son's delivery, I began my genetic journey by taking a 'direct to consumer' DNA test... When I got the results of the DNA test kit back, I was flagged for having a higher than normal risk of CV disease, Parkinson's and Alzheimers. In digging through the results, found out I can’t methylate folic acid - it’s approximately 7% of normal methylation capacity. I also learned that 40% of the population in the United States has some form of this mutation, but checking for it is not a standard of practice. The gene MTHFR codes for an enzyme that performs functions involved in building proteins and detoxifying cells. The mutation causes the enzyme to function inefficiently, causing inflammation in the brain and elevated homocysteine levels. This leads to inflammation throughout the body, circulatory system and especially the brain, causing higher risk for developing cardiovascular disease and neurological diseases like Parkinson’s and Alzheimer’s. This all pointed back to my genetic mutation causing dangerous nutrient deficiencies like the one that caused my son’s near-neural tube defect. As a result of the genetic test, I’m able to take the exact supplements my body needs to combat inflammation and hopefully decrease my risk of developing a neurological disease. My experience has motivated me to want to help others, especially young women trying to conceive. FOLIC ACID MAY NOT WORK FOR YOU. We are also seeing genetics linked to depression and ADHD, so my genetic consulting program focuses on testing children on psychoactive medications for a genes that impact how well the brain makes and clears dopamine, serotonin, and the neurotransmitters that affect memory and concentration. This provides a preventative option, offers potential alternative to stimulant medications and prevents “trial and error” prescribing. Shortly after I tested myself, I got certified in Pharmacogenomic testing. Then I became trained in Nutrigenomic testing. Then, I decided to start seeing if I could help others with my newfound knowledge. I took 3 beta testing patients, then the word spread. Friends and family began asking me if I could test them too. I worked with over a dozen 'beta testers' before I felt very confident in my services. I identified children with ADHD and on psychiatric medications as an area of interest of mine. I took on a few patients. After one of my recent consults, I had given the mother a list of about 10 things to try before starting the child on a stimulant medication. She was ecstatic. She told me she thought that I would tell her that nothing could be done and medication was their only option. If you've read my blog posts about starting my Genetic Consults business, then you know I was able to get the business up and running in just a few months. I didn't do it because I wanted to build a second business. No, my main focus is helping pharmacists build their career by building consulting businesses through the Pharmapreneur Academy. I treated the Genetic Consults business as an experiment so I could turn around and teach other pharmacists how to create a similar model. I'm working on putting together a wealth of information on cash-based services in Lesson 12 of the e-course at the Pharmapreneur Academy, which is launching December 16th, 2018. Lesson 12 is great for pharmacists interested in functional medicine consulting, pharmacogenomic and nutrigenomic testing, offering weight and hormone management programs! CLICK HERE TO LEARN MORE ABOUT HOW THE E-COURSE AT THE PHARMAPRENEUR ACADEMY CAN HELP YOU FULFILL YOUR CONSULTING DREAMS. ABOUT THE AUTHOR: Blair Green Thielemier, PharmD is an independent consultant pharmacist living in Arkansas with her husband and two children. Her latest project is the host and producer of pharmacy’s first virtual conference, the Elevate Pharmacy Virtual Summit in partnership with the NCPA Innovation Center. She is the founder of Pharmapreneur Academy, an online e-Course and Community where she guides pharmacist-entrepreneurs through the process and barriers of building a pharmacy consulting business. She is the author of How to Build a Pharmacy Consulting Business and facilitates in-person Business Planning Workshops and Mastermind Retreats for female Pharmapreneurs across the country. More information about Dr. Thielemier can be found on her website. 
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What is Nutrigenomic testing and how can a pharmacist use it in patient wellness consultations and supplement recommendations?
Nutrigenomic testing is similar to pharmacogenomic testing except we are looking at genes that specifically have to do with nutritional deficiencies. What genes are you testing? Some commonly tested genes are MTHFR, MTRR and FOLR1. These three genes are directly related to the methionine pathway and can impact the patient's homocysteine levels and folic acid levels. Some other genes that we're looking at and testing with Nutrigenomics is GAD1, GSTM, interleukins and HLA-DQA1 which is an indicator of gluten intolerance. There are no CPT codes that code for nutrigenomic testing and testing is not covered by insurance. Most of the pharmacists offering nutrigenomic and health and wellness consults are charging the patients cash. The cash price to the patient would include whatever test you'll be running, plus the consultant pharmacist's consultation fee and then certain supplement recommendations. On top of the pharmacist's consultation fee some opportunity for pharmacists to impact patients in nutrigenomic testing is to offer supplement recommendations as part of a health and wellness consult that identifies what nutritional deficiencies. The consultant may need to address any changes in diet that the patient may need to undergo as well to help impact and improve their genetic makeup by modifying gene expression (epigenetics). How could a consultant pharmacist offer nutrigenomic tests? In addition sometimes a nutrigenomic test can identify opportunities for pharmacogenomic testing. For instance some nutrigenomic tests, will test the COMT gene and the MTHFR gene which we also see on many pharmacogenomic panels. Pharmacists are seeing an opportunity to help patients through offering them high quality supplement recommendations and by using natural products like CBD oils. As more and more patients are looking for a more natural and holistic approach to medication therapy and preventative medicine, consultant pharmacists who are interested in functional medicine can use nutrigenomic testing to identify and remedy nutrient deficiencies that the patient may be experiencing. How can you put a program like this together? A consultant pharmacist in an off site setting such as a community pharmacy or independent consulting firm could provide nutrient deficiency consultations, microbiome and food sensitivity testing, nutrigenomic testing and weight management as part of a holistic health and wellness consultation program. If you are interested in building your clinical services... Join us on our next LIVE webinar to learn more about Pharmacy Consulting and the Pharmapreneur Academy. We'll discuss Protecting Yourself From Career Climate Change with Consulting as a Side Business Register now! ABOUT THE AUTHOR: Blair Green Thielemier, PharmD is an independent consultant pharmacist living in Arkansas with her husband and two children. Her latest project is the host and producer of pharmacy’s first virtual conference, the Elevate Pharmacy Virtual Summit in partnership with the NCPA Innovation Center. She is the founder of Pharmapreneur Academy, an online e-Course and Community where she guides pharmacist-entrepreneurs through the process and barriers of building a pharmacy consulting business. She is the author of How to Build a Pharmacy Consulting Business and facilitates in-person Business Planning Workshops and Mastermind Retreats for female Pharmapreneurs across the country. More information about Dr. Thielemier can be found on her website. 
Want to watch a video version of this post? I've got you covered! What is Pharmacogenomic (PGx) Testing? Pharmacogenomic testing is identifying genes that may affect enzymes responsible for hepatic metabolism of certain medications. Remember back in pharmacology and genetics you may remember learning about the Cytochrome P450 enzymes. Those enzymes are some of the ones that we look at in a pharmacogenomic test. What Genes Are Tested? In addition to the CYP450 enzymes, we also look at HLA-A and HLA-B, which indicate the presence of alleles linked to hypersensitivity to carbamazepine or phenytoin. We also look at OPRM1 which in our mind geotag specifically shows a decreased sensitivity to analgesic but it could go either way. We also look at the COMT which indicates whether or not the body is producing enzymes that can clear dopamine norepinephrine from the synapse. We also look at SLCO1B1 which tells us if the patient is more at risk for statin-induced myopathy. And finally for thrombosis risk we can look at genes that code for Factors 2, 5, and 10 Leiden. How Do You Bill for Pharmacogenomic Testing? As far as CPT codes go, there are no CPT codes that code specifically for pharmacogenomic testing. The patient can be referred to the pharmacist or to the physician for pharmacogenomic testing based on the medications that they're on and based on their diagnosis. Some impactful activities for pharmacists wanting to offer pharmacogenomic testing either in their community pharmacy setting or in a physician's office setting are:
To refer back to the incident to billing criteria, check out our last video on incident-to billing. How can you put a program like this together? A consultant pharmacist in an off site setting such as a community pharmacy or independent consulting firm could integrate pharmacogenomic testing and consultation into an MTM visit Lesson 9 in the E-course at the Pharmapreneur Academy is ALL about Pharmacogenomic and Point of Care Testing Services! If you are interested in building your clinical services... Join us on our next LIVE webinar, Sunday, November 18th at 8pmCDT Learn how to Protect Yourself From Career Climate Change with Consulting as a Side Business and how the Pharmapreneur Academy can help you build the Career of Your Dreams! Register HERE. ABOUT THE AUTHOR: Blair Green Thielemier, PharmD is an independent consultant pharmacist living in Arkansas with her husband and two children. Her latest project is the host and producer of pharmacy’s first virtual conference, the Elevate Pharmacy Virtual Summit in partnership with the NCPA Innovation Center. She is the founder of Pharmapreneur Academy, an online e-Course and Community where she guides pharmacist-entrepreneurs through the process and barriers of building a pharmacy consulting business. She is the author of How to Build a Pharmacy Consulting Business and facilitates in-person Business Planning Workshops and Mastermind Retreats for female Pharmapreneurs across the country. More information about Dr. Thielemier can be found on her website. 
Want a video version of this post? What is comprehensive medication management and how does it differ from continuous medication management? Comprehensive Medication Management is a program created by CMS to be included in the new Comprehensive Primary Care Plus (CPC+) clinic model The CPC+ model was created by MACRA as part of an advanced APM. Now remember in MACRA, there's two different payment tracks that clinics and providers can choose the MIPs route or the advanced APM route. The CPC+ model is application-only and it's only available in certain states and regions. "There are 2,900 primary care practices currently participating in Comprehensive Primary Care Plus (CPC+) in 18 regions: Arkansas, Colorado, Hawaii, Greater Kansas City Region of Kansas and Missouri, Louisiana, Michigan, Montana, Nebraska, North Dakota, Greater Buffalo Region of New York, North Hudson-Capital Region of New York, New Jersey, Ohio and Northern Kentucky Region, Oklahoma, Oregon, Greater Philadelphia Region of Pennsylvania, Rhode Island, and Tennessee." There are two different track models a CPC+ clinic can opt in to. In Track 2, there's an option mentioned to improve care through comprehensive medication monitoring. The idea behind comprehensive medication monitoring is to develop a plan after discharge or for those patients receiving longitudinal care management. There are four primary "change tactics" mentioned in Track 2 of the CPC+ model:
My thoughts for a program that includes a clinical pharmacist like this could include services like:
Providing comprehensive medication management programs and a CPC+ model is an opportunity for consultant pharmacists to help providers and focus on patient care outcomes. If you are interested in building clinical services like comprehensive medication management... Join us on our next LIVE webinar, Sunday, October 21st at 8pmCDT Learn the TOP 3 Mistakes Pharmacists Make in Their Careers and how the Pharmapreneur Academy can help you build the Career of Your Dreams! Register HERE. ABOUT THE AUTHOR: Blair Green Thielemier, PharmD is an independent consultant pharmacist living in Arkansas with her husband and two children. Her latest project is the host and producer of pharmacy’s first virtual conference, the Elevate Pharmacy Virtual Summit in partnership with the NCPA Innovation Center. She is the founder of Pharmapreneur Academy, an online e-Course and Community where she guides pharmacist-entrepreneurs through the process and barriers of building a pharmacy consulting business. She is the author of How to Build a Pharmacy Consulting Business and facilitates in-person Business Planning Workshops and Mastermind Retreats for female Pharmapreneurs across the country. More information about Dr. Thielemier can be found on her website. 
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What counts as a transition of care?
Eligibility:
Many time a post-discharge Transitional Care Management Service can be integrated into an existing CCM program. What are the CPT Codes for billing? 99495 ~$164 for non-facility setting ~$135 for facility setting Includes:
99496 ~$231 for non-facility setting ~$197 Includes:
What services a Consultant Pharmacist could offer to patients undergoing Transitions of Care?
How can you put a program like this together? A consultant pharmacist in an off site setting such as a community pharmacy or independent consulting firm could provide the primary touch point for a patient in the 48 hours post discharge. This consultant would need to be engaged in a financial relationship with the physicians office and generally needs to be under a collaborative practice agreement, though not exclusively necessary. Lesson 7 in the E-course at the Pharmapreneur Academy is ALL about the CCM and TCM codes for billing for pharmacist services! If you are interested in building your clinical services... Join us on our next LIVE webinar, Sunday, October 21st at 8pmCDT Learn the TOP 3 Mistakes Most Pharmacists Make in Their Careers and how the Pharmapreneur Academy can help you build the Career of Your Dreams! Register HERE. ABOUT THE AUTHOR: Blair Green Thielemier, PharmD is an independent consultant pharmacist living in Arkansas with her husband and two children. Her latest project is the host and producer of pharmacy’s first virtual conference, the Elevate Pharmacy Virtual Summit in partnership with the NCPA Innovation Center. She is the founder of Pharmapreneur Academy, an online e-Course and Community where she guides pharmacist-entrepreneurs through the process and barriers of building a pharmacy consulting business. She is the author of How to Build a Pharmacy Consulting Business and facilitates in-person Business Planning Workshops and Mastermind Retreats for female Pharmapreneurs across the country. More information about Dr. Thielemier can be found on her website. 
On Saturday, September 22nd, 2018 nine female pharmacists met in Nashville, TN to spend a day together working ON our businesses and identifying ways to support one another.
Masterminding is a concept made famous by Napoleon Hill's classic "How to Think and Grow Rich". Wikipedia describes Masterminding as... A mastermind group is a peer-to-peer mentoring concept used to help members solve their problems with input and advice from the other group members. The concept was coined in 1925 by author Napoleon Hill in his book The Law of Success, and described in more detail in his 1937 book, Think and Grow Rich. In his books, Hill discussed the idea of the Master Mind, which referred to two or more people coming together in harmony to solve problems. Recently, small business owners have taken this concept to a whole new level in the "facilitated Mastermind". A facilitated Mastermind is a formal meeting of entrepreneurs who come together to help each other with their businesses. The best facilitated Masterminds are between 6 & 8 people, diverse enough to support each others strengths and weaknesses and homogeneous enough so that the business owners are at similar points in their business journey. I, myself, have been involved in Masterminds throughout my business journey. In 2016, I participated in a 6 month Mastermind with other women with online businesses. In 2017, I participated in a 9 month Mastermind with other women with 6-figure businesses which were both online and brick and mortar. And this year in 2018, I'm working directly with two other business owners one male, one female who are at the 7-figure business level in hopes to learn from them and grow the impact of the Pharmapreneur Academy. Pharmacy's First Formal Mastermind Event The Female Pharmapreneur Business Development Retreat was pharmacy's first (to my knowledge) facilitated Mastermind ever. Represented by our group was 8 states: Arkansas, California, Colorado, Georgia, Kentucky, Missouri, Oklahoma and Tennessee. Also represented was various specialties, from compounding to non-profit to insurance payers to naturopathic medicine. It was truly a very special group and something I hope to offer again in the near future. I also want to thank Live Oak Bank for sponsoring part of this event and for sharing information with us on the various opportunities for investing in our business and calculating a return-on-investment. 
The structure of the day's agenda:
Upon completion of the Workshop, each attendee was presented with their own copy of the 2019 Business Development Planner, now available on Amazon. Our Homework for the Retreat was to:
Also, we committed to staying focused on actions that move us closer to those goals and give us permission to say "NO" to opportunities that don't align with those goals. As nine women gathered together, we felt the power of diverse backgrounds, diverse ways of thinking and the collective power of the Master Mind. It was truly a magical experience and something I plan to offer again in 2019. If you're interested in our next event, let me know and I'll add you to our waiting list. To stay in contact with all the happenings in the Pharmapreneur Academy Community join our mailing list at BTPharmacyConsulting.com/Newsletter ABOUT THE AUTHOR: Blair Green Thielemier, PharmD is an independent consultant pharmacist living in Arkansas with her husband and two children. Her latest project is the host and producer of pharmacy’s first virtual conference, the Elevate Pharmacy Virtual Summit in partnership with the NCPA Innovation Center. She is the founder of Pharmapreneur Academy, an online e-Course and Community where she guides pharmacist-entrepreneurs through the process and barriers of building a pharmacy consulting business. She is the author of How to Build a Pharmacy Consulting Business and facilitates in-person Business Planning Workshops and Mastermind Retreats for female Pharmapreneurs across the country. More information about Dr. Thielemier can be found on her website. 
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Medicare Part B covers medical nutrition therapy (MNT) services and some related services that integrate nicely with what a Consultant Pharmacist can offer.
However, MNT must be provided by a registered dietitian or a nutritional professional who meets certain requirements. This is a GREAT option for pharmacists who also have a professional background in nutrition. Even though MNT can only be provided by a nutrition professional, it still MUST be ordered by a doctor. MNT services may include:
A pharmacist with a nutrition degree could provide MNT services as an off-site consultant. For patients being treated in a dialysis facility, Medicare covers MNT as part of your overall dialysis care. Codes and Criteria: 97802 – MNT; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes 97803 – MNT; re-assessment and intervention, individual, face-to-face with the patient each 15 minutes 97804 – MNT; group (2 or more individual(s)), each 30 minutes G0270 – MNT reassessment and subsequent intervention(s) for change in diagnosis, individual, each 15 minutes G0271 – MNT reassessment and subsequent intervention(s) for change in diagnosis, group (2 or more), each 30 minutes
How you can utilize this code: MNT should not be confused with diabetes self-management training (DSMT), however. DSMT is an education and training program that helps patients manage their diabetes, whereas MNT consists of more individualized diagnosis, therapy, and counseling related to nutrition. According to the American Dietetic Association's 2009 White Paper on Nutrition Services that distinguishes between the delivery of DSMT and MNT services, the DSMT curriculum that is accredited by Medicare consists of 1 hour of individualized assessment and 9 hours of group classes. DSMT curriculum is focused on “incorporating nutritional management into lifestyle,” and “using medications safely and for maximum therapeutic effectiveness.” Sometimes it may be most helpful for patients to receive DSMT first, followed by MNT. Other patients may receive DSMT and MNT simultaneously. A consultant pharmacist may partner with a nutritional professional to offer a collaborative DSMT/MNT program. What services are you implementing in 2019? Leave me a note in the comments or join our Pharmapreneur Community Newsletter and email me directly! ABOUT THE AUTHOR: Blair Green Thielemier, PharmD is an independent consultant pharmacist living in Arkansas with her husband and two children. Her latest project is the host and producer of pharmacy’s first virtual conference, the Elevate Pharmacy Virtual Summit in partnership with the NCPA Innovation Center. She is the founder of Pharmapreneur Academy, an online e-Course and Community where she guides pharmacist-entrepreneurs through the process and barriers of building a pharmacy consulting business. She is the author of How to Build a Pharmacy Consulting Business and facilitates in-person Business Planning Workshops and Mastermind Retreats for female Pharmapreneurs across the country. More information about Dr. Thielemier can be found on her website. 
Want a video version of this post? I've got you covered! Diabetes self-management training (DSMT) is an education program that can be provided to eligible newly diagnosed Medicare beneficiaries. Patients are eligible for 10 hours within the first year of diagnosis and then 2 hours each year thereafter. Education can be provided via group sessions (> 2 patients) or individually, though individual education must be justified. CPT Codes G0108, individual, per 30 minutes and G0109, group session, per 30 minutes Criteria
Eligibility Who Is Covered? Certain Medicare beneficiaries when all of the following are true:
Frequency? Initial year: Up to 10 hours of initial training within a continuous 12-month period Subsequent years: Up to 2 hours of follow-up training each year after the initial year
Opportunities for Consultant Pharmacists to Use the Codes DSMT probably has the most difficult criteria to meet since the organization must be accredited by either the ADA or AADE. However, overall gaining accreditation isn’t too difficult and if you are partnering with a provider who sees many diabetic patients helping them gain accreditation opens up an additional revenue stream. Once accreditation has been established you can partner with the physician to provide DSMT. Remember, DSMT must be ordered by the provider first. Then the pharmacist can deliver the service. It does not require a collaborative practice agreement unless you are making changes to the patients therapies. Just as with the diabetes prevention programs, if monitoring patient data such as blood sugar, weight, or physical activity electronically you can also utilize the remote patient monitoring code. The next opportunity we'll discuss is Medical Nutrition Therapy. Sign up for the Pharmapreneur Community Newsletter and get it delivered directly to your Inbox! ABOUT THE AUTHOR: Amy Henneman, PharmD, BCACP, BCPS, CDE is an associate professor of pharmacy practice living in south Florida with her husband and two children. Her practice has been focused in building ambulatory care services and working to provide expanded care to low income patients. She enjoys working with both providers and other pharmacists to assist them in offering expanded pharmacy services. 
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Remote Patient Monitoring: An Opportunity for Consultant Pharmacists?
Effective January 1st, 2018, the Centers for Medicare and Medicaid Services will begin reimbursing for remote patient monitoring (RPM). So, what is RPM? For starters, NOT telehealth services, which is actually a good thing. While telehealth services do exist, they have several specifications that can make widespread use a little tricky. So what about RPM? RPM is the use of digital technology to collect health data from a patient that is then transmitted electronically and securely to a healthcare provider in another location for assessment and recommendation. CMS is now going to reimburse providers for that assessment and recommendation portion, if it constitutes at least 30 minutes of provider time per month, using CPT 99091. This means for those patients participating in home glucose or blood pressure monitoring, INR, and even potentially genetic reports, the provider now has the opportunity to receive approximately $60 per month for their time spent reviewing, assessing, and making recommendations regarding the patient’s care plan. So what are the specifications? Most notable is that CMS stated the service must be provided by the practitioner, not clinical staff. For now, using this code means utilizing incident to billing. Consent must be obtained and documented from the patient, and for all new patients or those that have not been seen within the last 12 months, they must have an initial visit. The code can be billed once per month for each patient as long as the practitioner is receiving information electronically that impacts the patient’s care. This opens another potential revenue stream for savvy Pharmapreneurs. For pharmacists partnering with physicians to offer MTM or consulting services who meet the criteria for incident to billing, this is another service you can offer to your providers. If you are already spending time reviewing medications and/or making adjustments to medications, most likely this service is an extension of what you are already doing. Before making a recommendation or an adjustment to a patient’s insulin regimen, you probably want to see the patient's blood sugar logs. If the patient is able to send them electronically, there’s an opportunity to utilize RPM. If you are already using the chronic care management codes (CPT codes 99487, 99489, and 99490), RPM can be billed in conjunction with these. As CMS moves towards innovation and expanded integration of technology, this means big opportunities to be on the forefront of this move forward. Remote Patient Care Monitoring is the use of digital technology to collect health data from a patient that is then transmitted electronically and securely to a healthcare provider in another location for assessment and recommendation. CPT Code 99091 The Center for Medicare and Medicaid Services (CMS) reimburses providers for that assessment and recommendation portion, if it constitutes at least 30 minutes of provider time per month. Billing Criteria The service must be provided by the practitioner, not clinical staff. So for now, using this code means utilizing incident to billing. Consent must be obtained and documented from the patient, and for all new patients or those that have not been seen within the last 12 months, they must have an initial visit. The code can be billed once per month for each patient as long as the practitioner is receiving information electronically that impacts the patient’s care. Information transmitted electronically must be transmitted in a protected manner. Opportunities for Consultant Pharmacists For pharmacists partnering with physicians to offer MTM or consulting services who meet the criteria for incident to billing, this is another service you can offer to your providers. If you’re thinking diabetes management the first thing you should think of is blood sugar monitoring. Home blood sugar monitoring is necessary for most patients and something we ask for often. This information could be transmitted electronically and the time you spend reviewing the information billed for using this code. Additionally, if you partner with a provider to offer a diabetes prevention program or diabetes self-management training, electronic transmission of items such as patient weight and physical activity could also qualify for remote patient monitoring, giving you more bang for your time. The next opportunity we'll discuss is remote patient monitoring. Sign up for the Pharmapreneur Community Newsletter and get it delivered directly to your Inbox! ABOUT THE AUTHOR: Amy Henneman, PharmD, BCACP, BCPS, CDE is an associate professor of pharmacy practice living in south Florida with her husband and two children. Her practice has been focused in building ambulatory care services and working to provide expanded care to low income patients. She enjoys working with both providers and other pharmacists to assist them in offering expanded pharmacy services. |
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