title: Retrospective analysis of billing at a standalone medication therapy management clinic.
abstract: OBJECTIVE
  Results of a study comparing reimbursement for medication therapy management (MTM) services with a resource-based relative value scale (RBRVS) versus a time-based billing model are reported.
  
  
  METHODS
  Reimbursement claims for MTM services provided by a standalone clinic during a 6.5-year period were reviewed. Actual billing amounts calculated according to Minnesota's RBRVS for MTM services, which emphasizes case complexity as a determinant of payment rates, were compared with hypothetical billing amounts calculated using a strictly time-based method designed to more accurately capture the costs of providing MTM services. A paired t test was conducted to analyze differences in the billable amounts calculated via the two methods.
  
  
  RESULTS
  Reimbursement claims for a total of 525 face-to-face MTM encounters with 60 patients were analyzed. Using the RBRVS method, the mean ± S.D. billing amount per encounter was $83.71 ± $36.67; using the strictly time-based method, the mean ± S.D. billing amount was $111.83 ± $34.55 per encounter (mean difference, $28.12; p < 0.0001). These findings indicate that the use of time-based versus RBRVS-based billing methodology would have resulted in an additional $14,763 in MTM services reimbursement for the 525 evaluated encounters.
  
  
  CONCLUSIONS
  The RBRVS-based method consistently resulted in a lower billing amount per encounter than the strictly time-based billing method, suggesting that reimbursement for MTM services may not be aligned with the actual costs of providing those services.
authors.affiliation: College of Pharmacy, University of Minnesota, Duluth (khager@umn.edu).
authors.forename: Keri D
authors.initials: KD
authors.lastname: Hager
authors.affiliation: University of Wisconsin Hospital and Clinics, Madison.
authors.forename: Rena A
authors.initials: RA
authors.lastname: Gosser
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D054539:Medication Therapy Management / Q000191:economics*; D008875:Middle Aged; D008910:Minnesota; D010593:Pharmaceutical Services / Q000191:economics*; D012051:Reimbursement Mechanisms / Q000191:economics*; D012189:Retrospective Studies