BCACP Ambulatory Practice Business Models 4 — Questions and Answers
Question 1: Which organization's accreditation standards are MOST relevant for ambulatory care pharmacies seeking to demonstrate quality in medication therapy management and care coordination?
- The Joint Commission (TJC)
- URAC (formerly Utilization Review Accreditation Commission)
- National Committee for Quality Assurance (NCQA) (Correct answer)
- Accreditation Council for Pharmacy Education (ACPE)
Correct answer: National Committee for Quality Assurance (NCQA)
NCQA accredits health plans and MTM programs and its HEDIS measures are used to evaluate pharmacist-related quality performance in ambulatory settings.
Question 2: A pharmacist hired as a direct employee of a physician group practice typically bills services under which arrangement?
- Independent pharmacist provider billing
- Incident-to the supervising physician's billing (Correct answer)
- Stand-alone Part D MTM billing
- FQHC bundled billing only
Correct answer: Incident-to the supervising physician's billing
When employed by a physician practice, pharmacists most commonly bill under the incident-to provision, using the physician's NPI.
Question 3: When calculating the return on investment (ROI) of a pharmacist-managed hypertension program, which formula is CORRECT?
- ROI = (Net Benefit / Total Cost) × 100% (Correct answer)
- ROI = (Total Revenue / Fixed Costs) × 100%
- ROI = (Number of Patients Served / FTE Cost) × 100%
- ROI = (Variable Costs / Break-even Volume) × 100%
Correct answer: ROI = (Net Benefit / Total Cost) × 100%
ROI is calculated as net benefit (savings minus costs) divided by total investment cost, expressed as a percentage.
Question 4: A pharmacist practice at a retail pharmacy chain wants to offer clinical services. The PRIMARY regulatory barrier is MOST likely:
- Lack of CPT codes for pharmacy services
- State scope-of-practice laws limiting pharmacist prescriptive authority (Correct answer)
- Absence of pharmacy benefit manager interest
- Federal prohibition on pharmacy-based clinical services
Correct answer: State scope-of-practice laws limiting pharmacist prescriptive authority
State-specific scope-of-practice legislation is the primary regulatory determinant of what clinical services pharmacists may legally provide.
Question 5: Which stakeholder analysis step helps identify individuals who can influence the success or failure of a new ambulatory pharmacy service?
- SWOT analysis
- Pro forma modeling
- Stakeholder mapping (Correct answer)
- Gantt chart development
Correct answer: Stakeholder mapping
Stakeholder mapping identifies key individuals and groups, their level of influence, and their stance toward the proposed service.
Question 6: A pharmacist-run chronic care management (CCM) program bills Medicare for monthly coordination of complex patients. The MINIMUM requirement for CCM billing is at least how many minutes of non-face-to-face care per calendar month?
- 10 minutes
- 20 minutes (Correct answer)
- 30 minutes
- 60 minutes
Correct answer: 20 minutes
Medicare requires at least 20 minutes of non-face-to-face clinical staff time per calendar month to bill the base CCM code (99490).
Question 7: In a telepharmacy model serving a rural community, which federal designation MOST likely enables enhanced reimbursement for pharmacist clinical services?
- Critical Access Hospital (CAH) affiliated service
- Rural Health Clinic (RHC) provider status (Correct answer)
- Urban enterprise zone classification
- Community pharmacy preferred network status
Correct answer: Rural Health Clinic (RHC) provider status
Rural Health Clinics receive cost-based reimbursement from Medicare and Medicaid, which can include pharmacist services within the RHC setting.
BCACP Ambulatory Practice Business Models 4
Which organization's accreditation standards are MOST relevant for ambulatory care pharmacies seeking to demonstrate quality in medication therapy management and care coordination?