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BCACP-MANAGED CARE 3 AND BCACP-REGULATORY
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BCACP-MANAGED CARE 3
BCACP-REGULATORY
BCACP-MANAGED CARE 3
Mission of pharmacist - ANSWER>>improve public health through ensuring the safe, effective and appropriate use of medications
4 major clinical pharmacy practice models - ANSWER>>pharmaceutical care, MTM, comprehensive medication mgmt, CDTM
Goal of pharmaceutical care? - ANSWER>>optimize patients health related quality of life, achieve positive clinical outcomes
Medication therapy managemetn definition? CMS - ANSWER>>servive or group of services that optimizes therapeutic outcomes for individual patients. Optimize outcomes throught improved med use, reduce AE and drug interactions, improve adherence
Who is targetted? - ANSWER>>Several chronic diseases, multiple mediations, cost over 3017$/year
What must be done for CMR? TMR? - ANSWER>>annually, quarterly
Other CMS MTM requirements? - ANSWER>>need MTM infor on plans website, must have process to meaure analyze and report MTM outcomes
CPT coes for MTM? - ANSWER>>No revenue associated at this time. 99605 initial face
to face 15 minutes, 99606 established 15 minutes, 99607 is any additional 15 minute blocks
Who developed the patient centered medical home definition/standards? - ANSWER>>NCQA
What are the 3 elements of comprehensive medication managmenet? - ANSWER>>ASsessment, care plan, follow-up
What patients are good for CMM? - ANSWER>>high cost, adherence issues, risk of hospital admin
what sort of CMM communication? - ANSWER>>Needs to be bi-directional, written is one direction (so ansewer is face to vace telephonic or virtual
CDTM collab practice agreement - ANSWER>>k
How often should CDTM be reviewed and updated - ANSWER>>every 2 years, keep agreement on file in place of service
Key elements of CDTM success? - ANSWER>>access to pateint medical records, knowledge, documetnation in teh patient medical records, accountability for quality measures, ability to be reimbursed, committed tiem and resources
when must med guides be provided for REMS? - ANSWER>>ALL settings, hospital, admin by health care provider etc
When an IND application must be submitted. - ANSWER>>After preclinical studies but before a clinical study.
Which of the following requires an IND application? - ANSWER>>New drug, new indication, off-label use
What is 45 CFR part 46? - ANSWER>>Protection of human subjects
Definitional of credential vs privileg - ANSWER>>credent: documented evidence of professional qualification; privileging: process to grant practicioiner the auth to provide specific services
For vaccinations does medicare part B have deductable or copays? - ANSWER>>no
Vaccines can have vaccine medicare part D coverage - ANSWER>>.
What are transitional care managemetn codes? - ANSWER>>99495 99496 (high complexity) face to face visit
Which vaccines are covered under medicare part B - ANSWER>>pneumococcal influenza hep B and any vaccine necessary to treat an injury/illness
What is necessary before being able to administer Part B vaccines? - ANSWER>>enrolll with medicare admin contractor before influenza seaseon, need national provider identifer before enrollement
What sort of billing for medicare B? - ANSWER>>roster billing, centralized billing
how are other vaccines billed? - ANSWER>>part D
What established medicare coverage for AWV? q - ANSWER>>2011 affordable care act
When are patients eligible for AWV? - ANSWER>>after 12 months of part B coverage
Key components of AWV? - ANSWER>>Health risk assessment, evaluate cog impairment, list of current providers, written screening schedule established
Billing for AWV? - ANSWER>>G0438 is initial, G0439 is subsequent, no copayment or deductable
What are not the usual things required for AWV? - ANSWER>>a change in the patients therapy
Does credentialing and privilaging increase or decrease legal liability of health care org? - ANSWER>>decrease (still liable if allowing unqualified practitioner)
What is medwatch FDA form 3500 and 3500 A - ANSWER>>3500 is voluntary health care professional reporting, 3500 a for mfgr,packer, distributers
CAn I disclose PHI to the governemnt entities for public health purposes? - ANSWER>>Yes
what must a generic drug do in order to be approved as a generic? Approval pathway? - ANSWER>>bioequivalence; ANDA (abreviated)
AB rated A rated B rated? - ANSWER>>.
BCACP REGULATORY
What is the HCPCS? - ANSWER>>healthcare common procedure coding system, level 1 are the CPT codes
What is an incident - to visit? - ANSWER>>transition of care visit
what are the indicent to codes and what do they mean? - ANSWER>>99496 (seen in 7 days from discharge), 99495 (seen within 14 days of discharge)
what provided us with the opportunity for MTM services? - ANSWER>>medicare prescription drug, improvemnt and modernization act of 2003
what are the eligibility requirements for MTM? - ANSWER>>3 chronic health conditions, 5-9 core chronic conditions, 8 part D meds, costs of 3017 or greater
what are teh MTM CPT codes? - ANSWER>>99605 (new patient initial 15 min), 99606 (established patient face to face, 15 min), 99607 (face to face visit for extra 15 minutes
4 committees within the senate have jurisdiction over halth related policy - ANSWER>>appropriation committee (discretionary programs), finance committee (taxation and heatlth programs under social security act like medicare, medicaid, and childrens health), health education labor and pension, veterans affairs committee
What is the ways and means? - ANSWER>>from house of rep, taxation and most programs auth by social security act
american recovery and reinvestment act of 2009? - ANSWER>>vehicle for passing the health information tech for economic and clinical health act. promote HIT including EHR. Provide incentives, by medicare, to be meaninful users
What is meaningful use as it pertains to American Recovery and Reinvestment Act of 2009? ANSWER>>Use of EHR in meaningful manner (e-script), use of EHR for health information exchange, use of EHR to submit clinical quality and other measures, Incentives until 2015 then penalties
ACA 2010 (patient protection and affordable care act) - ANSWER>>protecting consumers to improving health care quality and lowering cost to increasing access to care.
who administers medicare, medicaid, and state childrens halth insuranc eprogram? - ANSWER>>CMs
what does the agency for healthcare research and quality (AHRQ)do? - ANSWER>>supports research that helps people make better informed decisions and improves the quality of healthcare services
wht is the abbreviated new drug application? - ANSWER>>new generic drug
which act established regluatory approval pathway for biosimilars or follow0on biologics? - ANSWER>>ACA
What is a phase 1 trial? - ANSWER>>usually 20-80 volunteers, goal to get info on PK and PD properties
What is a Phase 2 trial? - ANSWER>>no more than several hundreds, goal to evaluate the drug's effectiveness fora particular indication in patients with the disease or condition and determin common short term E and risks
Phase 3 - ANSWER>>range of several hundred to several throughsn to determine safety, efficacy and dose
phase IV - ANSWER>>may be required by FDA to ID additional information about drugs risks, benefits and optimal use, verify effectiveness in specific populations
where can you find all the fda approved products? - ANSWER>>orange book (approved rug products with theraptutic equivalence)
what were teh congressional responses to "to err is human" - ANSWER>>patient safety and quality improvement act of 2005
What was the purpose of the Patient Safety and Quality Improvement Act of 2005? - ANSWER>>Encourages health care providers and OGs to voluntaritly report and share patient safety info with fear of legal action; created patiene saftey organiztions,
Which agency established a patient safety org provacy protection center through teh pateint safety and quality improvemnt act of 2005? - ANSWER>>AHRQ
What is a form for this? site? - ANSWER>>medwatch, ISMP
what is ISMP? - ANSWER>>non profit PSO (patient safety org)- publishes med safet alerts
What does FDA do? - ANSWER>>approves new medication and issues warnings or other recommendations for already approved meds
What does CMS and HHS do? - ANSWER>>determine rules and regs for federally sponsored health care or medicare and other national health care laws
What does CDC do? - ANSWER>>determines rules and starndard procedures for point of care testing, immunizations, and mgmt of patients with transmittable diseases
what org are NCQA, PCMH, joint commission, CPPA? -ANSWER>>accreditation organizations, establish standards for quality an dsafety.
NCQA? - ANSWER>>works to improve health care quality through the administration of utilizes evidence-based standards, measures, programs, and accreditation. The private, nonprofit organization operates on a formula of measure, analyze, and improve. And it aims to build consensus across the industry by working with policymakers, employers,
doctors, and patients, as well as health plans.
What measures does NCQA have? - ANSWER>>Hedis (Healthcare Effectiveness Data and Information Set
Which recent law changed the landscape for documentation creating meaninguf use initiatives? incentivezes health care organization to use electronic portals for documentation - ANSWER>>american recovery and reinvestment act of 2009
What organization sets the national strategy for quality imporvemnt? - ANSWER>>AHRQ agency for healthcare research and quality
What is the public resource for evidence based quality measures? - ANSWER>>national quality measures clearinghoue (NQMC)
What doe the IOM institute of medicine does? - ANSWER>>independent, nonprofit, role is to work outside govt to provide unbiased and authoritative adice to decisionmakers and the public
Pharmacy quality alliance role? - ANSWER>>assurance of provision of quality services to medicare beneficiaries and all patientts
Why was NCQA founded in 1979? - ANSWER>>to review PPO and HMO
Who utilizes the HEDIS that NCQA developed? - ANSWER>>for employers to evaluate the health plans they use for employee benefits
What else does NCQA provide? - ANSWER>>ACO accreditation, PCMH recognition, diabetes mgmt rec program
What is the CPPA established in 2012? - ANSWER>>The Center for Pharmacy Practice
