BCACP Ambulatory Practice Business Models 3

Question 1

Which term describes a payment model where providers receive a fixed payment per patient per month to cover all specified services, regardless of utilization?

Accepted Answer

Capitation

Answer

Capitation provides a fixed per-member per-month payment, incentivizing providers to deliver preventive care and reduce unnecessary utilization.

Question 2

An ambulatory care pharmacist is proposing a diabetes management program. Which financial document projects the expected revenues and expenses over the first 3 years?

Accepted Answer

Pro forma income statement

Answer

A pro forma income statement projects anticipated revenues and expenses over a future period to estimate profitability of a proposed program.

Question 3

Under which model do pharmacists share in the savings achieved when total cost of care falls below a benchmark, while also being accountable for quality metrics?

Accepted Answer

Accountable Care Organization (ACO)

Answer

ACOs allow providers including pharmacists to share in savings generated by coordinating care and reducing costs below a pre-set benchmark.

Question 4

A hospital-based outpatient pharmacy clinic loses money on a per-encounter basis but the hospital retains the service. This is MOST likely because:

Accepted Answer

The service generates downstream revenue through reduced readmissions and increased admissions

Answer

Hospital systems often subsidize ambulatory pharmacy services because they reduce costly readmissions and attract patients whose inpatient care generates significant revenue.

Question 5

Which CPT code category is MOST commonly used to bill for Medication Therapy Management Comprehensive Medication Review (CMR) services?

Accepted Answer

MTM-specific CPT codes 99605-99607

Answer

CPT codes 99605-99607 are specifically designated for billing pharmacist-provided MTM services including the CMR.

BCACP - Board Certified Ambulatory Care Pharmacist Exam Practice Test

BCACP - Board Certified Ambulatory Care Pharmacist Exam Practice Test

BCACP Ambulatory Practice Business Models 3