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Chapter 5. Payer Perspective

MTM may be sponsored by:

a. CMS Medicare.

b. employers.

c. Medicaid.

d. managed care organizations.

e. All of the above.

Part C performance measures are heavily influenced by:

a. HEDIS, which was developed by NCQA.

b. HEDIS, which was developed by JCAHO.

c. HEDIS, which was developed by PQA.

d. HEDIS, which was developed by CMS.

e. HEDIS, which was developed by the pharmacy group that created the MTM consensus document.

Reasons to select telephonic over face-to-face MTM delivery include all of the following EXCEPT:

a. ability to record each communication service for oversight and quality assurance of MTM providers.

b. limited distractions that may be present in a retail pharmacy setting (ie, no dispensing functions, drive-thru, or waiting patients).

c. ability to reach members unable to travel to a pharmacy (ie, non-ambulatory members).

d. they are proven more effective than busy retail pharmacy setting.

e. elimination of judgments on the part of the provider or patient, based on the physical attributes of the other.

MTM services provided to patients who are not enrolled in Part D are:

a. not required to follow CMS guidelines.

b. required to follow HEDIS measures.

c. required to be part of an ACO.

d. required to use pharmacists as providers.

e. required to provide a medication action plan.

Complementary programs to MTM can include:

a. a newsletter.

b. a toll-free pharmacy hotline.

c. educational materials.

d. pill boxes.

e. All of the above.

When deciding between MTM program insourcing versus outsourcing, consideration must be given to all of the following EXCEPT:

a. quality assessment process.


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