BCACP Ambulatory Practice Business Models 2

Question 1

Which billing model allows pharmacists to bill for cognitive services under a 'incident-to' arrangement in an outpatient clinic?

Accepted Answer

Incident-to physician billing under Medicare Part B

Answer

Pharmacy Benefit Manager (PBM) model

Answer

Medicare Part D medication management

Answer

State Medicaid fee-for-service

Question 2

A pharmacist-run anticoagulation clinic wants to demonstrate its value to hospital administration. Which metric is MOST compelling for a business case?

Accepted Answer

Reduction in warfarin-related hospitalizations and associated cost savings

Answer

Number of INR tests performed monthly

Answer

Average time-in-therapeutic range (TTR) percentage

Answer

Number of patient education sessions completed

Question 3

In a Patient-Centered Medical Home (PCMH) model, the ambulatory care pharmacist's role is BEST described as:

Accepted Answer

Integrated team member providing medication management within care coordination

Answer

Independent prescriber operating a separate clinic

Answer

Consultant who reviews charts remotely without patient contact

Answer

Dispenser responsible for medication synchronization only

Question 4

Which reimbursement mechanism most directly supports pharmacist-provided Medication Therapy Management (MTM) services under Medicare?

Accepted Answer

Medicare Part D standalone MTM program funding

Answer

Medicare Part A inpatient DRG payments

Answer

Medicare Part B incident-to billing

Answer

Medicare Advantage supplemental benefit payments

Question 5

A collaborative practice agreement (CPA) in an ambulatory care setting PRIMARILY enables pharmacists to:

Accepted Answer

Initiate, modify, or discontinue drug therapy under defined protocols

Answer

Independently diagnose new disease states without physician involvement

Answer

Bill independently as a Medicare provider without physician supervision

Answer

Operate a dispensing pharmacy without a pharmacy license

Question 6

When developing a business plan for a new ambulatory pharmacy service, a break-even analysis is used to determine:

Accepted Answer

The volume of services required for revenue to equal total costs

Answer

The maximum number of patients the clinic can serve

Answer

The quality metrics needed for NCQA accreditation

Answer

The staffing ratio of pharmacists to technicians

Question 7

A federally qualified health center (FQHC) pharmacist provides clinical services. Under the FQHC prospective payment system (PPS), how are pharmacist services typically reimbursed?

Accepted Answer

Bundled into the FQHC per-visit encounter rate

Answer

Separately billed as independent pharmacist services per CPT code

Answer

Paid via a value-based care quality bonus only

Answer

Reimbursed directly through Part D regardless of service type