Documentation Standards & Regulatory Compliance Flashcards

Under the MTM documentation framework, a 'follow-up plan' included in the CMR written summary must address which of the following?

Answer: Scheduled follow-up interactions and criteria for re-evaluation of drug therapy problems

CMS guidance requires the CMR written summary to include a follow-up plan specifying when and under what circumstances the patient should be re-evaluated for identified drug therapy problems.

Which of the following best describes the purpose of an 'intervention' in MTM documentation?

Answer: A documented action taken by the pharmacist to resolve or prevent a drug therapy problem

An intervention in MTM documentation records the specific action the pharmacist took—such as contacting a prescriber or counseling a patient—to address an identified drug therapy problem.

OBRA '90 requirements most directly influenced MTM by establishing the mandate for pharmacists to:

Answer: Conduct prospective drug utilization review and offer patient counseling

OBRA '90 required pharmacists to conduct prospective DUR and offer counseling for Medicaid patients, laying the professional and regulatory groundwork for modern MTM services.

A pharmacist submits an MTM claim using CPT code 99605. This code is most appropriately used for:

Answer: An initial MTM service with a new patient, face-to-face, up to 15 minutes

CPT 99605 is designated for an initial MTM encounter with a new patient, face-to-face, for up to 15 minutes, and is distinct from follow-up or telephone-based service codes.

Which of the following situations requires the pharmacist to file a breach notification under HIPAA?

Answer: A pharmacist inadvertently emails a patient's MTM summary to the wrong patient and the error is not immediately correctable

An impermissible disclosure of PHI that cannot be mitigated triggers HIPAA breach notification requirements to the affected individual and, depending on scale, to HHS.

In electronic health record (EHR) integration for MTM, which documentation practice best supports interoperability with prescribers' systems?

Answer: Documenting clinical findings and recommendations using standardized terminologies such as SNOMED CT or RxNorm

Using standardized terminologies like SNOMED CT for diagnoses and RxNorm for medications enables structured data exchange between pharmacy and prescriber EHR systems.

Which element of an MTM encounter record provides the strongest evidence of patient engagement and shared decision-making?

Answer: Documented patient agreement or refusal of specific action items and the rationale discussed

Documenting whether the patient agreed with or declined specific action items, along with the discussion rationale, demonstrates shared decision-making and patient-centered care.