BCACP - Board Certified Ambulatory Care Pharmacist Ambulatory Practice Management Questions and Answers — Questions and Answers
Question 1: An ambulatory care pharmacist is developing a business plan to justify the implementation of a new comprehensive medication management (CMM) service within a primary care clinic. To make a compelling case to administration, which of the following components is MOST critical to include in the business plan?
- A detailed list of all potential drug information resources required.
- A multi-year projection of service revenue, operating expenses, and return on investment (ROI). (Correct answer)
- An extensive Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis of competing local pharmacies.
- The complete curriculum vitae of all pharmacists who will be providing the service.
Correct answer: A multi-year projection of service revenue, operating expenses, and return on investment (ROI).
While all components can be part of a business plan, the financial plan, including revenue projections, expenses, and ROI, is most critical for demonstrating the service's financial viability and value to administrative stakeholders. This section directly addresses the 'bottom line' and sustainability, which are primary concerns for decision-makers.
Question 2: A pharmacist in a physician's office provides an extensive medication review and counseling session for an established patient with Medicare Part B. The service is performed under a collaborative practice agreement. To bill for this service as 'incident-to' the physician, which of the following conditions is required?
- The pharmacist must have their own National Provider Identifier (NPI) and be enrolled as a Medicare provider.
- The service must be billed using the pharmacist-specific CPT codes 99605 or 99606.
- The physician must be present in the office suite during the pharmacist-provided service. (Correct answer)
- The patient must be seeing the pharmacist for their initial visit to establish care.
Correct answer: The physician must be present in the office suite during the pharmacist-provided service.
For a service to be billed 'incident-to' under Medicare Part B, the physician must provide direct supervision, which is defined as being physically present in the same office suite and immediately available to provide assistance and direction if needed. Pharmacists are not recognized Medicare providers and cannot enroll to bill Part B directly, and specific MTM codes are not used for 'incident-to' billing; instead, an E/M code like 99211 is typically used. 'Incident-to' billing is for subsequent services, not the initial patient visit.
Question 3: A clinical pharmacist at a busy anticoagulation clinic wants to reduce patient wait times. She decides to implement a quality improvement project using the Plan-Do-Study-Act (PDSA) model. Which of the following activities would occur during the 'Study' phase of the PDSA cycle?
- Developing a flowchart of the current patient check-in and testing process.
- Implementing a new scheduling template for a single day to test its effect.
- Analyzing the wait time data collected after implementing the new scheduling template. (Correct answer)
- Expanding the use of the new scheduling template to all clinic days.
Correct answer: Analyzing the wait time data collected after implementing the new scheduling template.
The 'Study' phase of the PDSA cycle involves analyzing the data and results gathered during the 'Do' phase. This includes comparing the results to the predictions made in the 'Plan' phase and summarizing what was learned. Planning the change occurs in the 'Plan' phase, testing the change occurs in the 'Do' phase, and implementing or refining the change based on the results occurs in the 'Act' phase.
Question 4: An ambulatory care pharmacist is providing MTM services to a new patient for the first time. The face-to-face visit lasts 18 minutes. Which CPT code(s) should be used to bill for this service?
- 99605 only (Correct answer)
- 99606 only
- 99605 and 99607
- 99211
Correct answer: 99605 only
CPT code 99605 is designated for the initial MTM service for a new patient, covering the first 15 minutes of a face-to-face encounter. The add-on code 99607 is for each additional 15 minutes and would not be used unless the service met or exceeded 30 minutes. 99606 is for an established patient, and 99211 is a general evaluation and management code, not specific to MTM.
Question 5: Which of the following is the most effective strategy for an ambulatory care pharmacy manager to justify the expansion of clinical services to a hospital's executive leadership?
- Presenting a summary of recent national surveys showing high pharmacist job satisfaction.
- Submitting testimonials from patients who are highly satisfied with current pharmacy services.
- Providing data demonstrating the service's positive impact on patient outcomes and cost savings. (Correct answer)
- Highlighting the advanced degrees and board certifications held by the pharmacy staff.
Correct answer: Providing data demonstrating the service's positive impact on patient outcomes and cost savings.
Executive leadership is primarily focused on clinical outcomes, quality metrics, and financial performance. Demonstrating that a service improves patient health (e.g., reduced readmissions, improved A1c levels) and provides a positive return on investment or cost avoidance is the most powerful justification for expansion. While patient satisfaction, staff qualifications, and job satisfaction are important, they are less compelling as primary justifications without accompanying clinical and economic data.
Question 6: A pharmacist is establishing a new transitions of care service in a health system. To ensure the service is financially sustainable, a key component of the practice management plan is to identify appropriate billing mechanisms. Which of the following represents a viable billing strategy for pharmacist-led transitions of care services under Medicare?
- Billing directly under the pharmacist’s provider number using MTM codes.
- Using facility fees only, as no professional service codes apply.
- Billing 'incident-to' a physician for services provided in the outpatient clinic post-discharge. (Correct answer)
- Enrolling the pharmacy as a durable medical equipment (DME) supplier.
Correct answer: Billing 'incident-to' a physician for services provided in the outpatient clinic post-discharge.
Since pharmacists are not recognized Medicare Part B providers, they cannot bill directly for most clinical services. However, services provided in an outpatient clinic as part of post-discharge follow-up can often be billed under the 'incident-to' provision, where the service is billed under the physician's provider number as an integral part of the physician's care. MTM codes are generally not reimbursed by Medicare Part B. Facility fees may apply but do not cover the professional component of the service, and becoming a DME supplier is not relevant to billing for cognitive services.
BCACP - Board Certified Ambulatory Care Pharmacist Ambulatory Practice Management Questions and Answers
An ambulatory care pharmacist is developing a business plan to justify the implementation of a new comprehensive medication management (CMM) service within a primary care clinic.
To make a compelling case to administration, which of the following components is MOST critical to include in the business plan?