Compensation Framework Flashcards
Pharmacist Delivered Services
- Legislated
Health Professions Act
- Defines scope of practice for pharmacists
Pharmacist Delivered Services
- Regulatory
Standards of Practice
Pharmacist Delivered Services
- Compensation Plan for Pharmacy Services
Ministerial Order
- Legal contractual details for compensation
Pharmacy Guide
- User friendly guide for interpreting MO
Who can bill government services
Only a pharmacist that has signed an agreement with ABBC can bill Government Services
- Have to be a licensed pharmacy
Can you bill other provinces
No, can only send bills based in Alberta
Can you provide Clinical Services to patients from outside Alberta
Yes, however, you still have to bill it to the pharmacy
- Pharmacy can not bill the government
Can only bill service for Resident of Alberta
Who does the pharmacy bill for government services
Can only bill the government or the patient
- NOT both
Pharmacy Services
Adapting a prescription
Altering Insulin order
Administrating a drug by injection
Administrating a publicly funded vaccine
CACP + Follow Up CACP
Continuity of Care
Prescribing initial access or mange ongoing therapy
Prescribing in emergency
Prescription renewal
Refusing to fill a prescription
SMMA + Follow Up SMMA
Trial Prescription
Can a Student Pharmacist bill a service
Service must be performed by a Clinical Pharmacist registered with ACP
- Student Pharmacist would have to be under supervision of a Clinical Pharmacist
- Billing is done under the name of the Clinical Pharmacist
Who processes the billing of services
Alberta Blue Cross
How many Services can you bill a resident per day
One fee per resident per day
- Some Exceptions
How many Injection Services can you bill a resident per day
Can bill two per day
Publicly funded vaccines have no defined limit
How long do Care Plane related Documentations have to be retained by the pharmacy
10 years past last date of service
- CACP, SMMA, Follow Ups, Physician CCP
CACP
- Definition
Comprehensive Annual Care Plan
- Preparation, documentation, and review of a care plan of an eligible resident with complex needs
- Aims to keep the patient in the community for longer
CACP
- Requirements
Must have 2 or more chronic conditions
OR
Must have 1 chronic condition AND 1 or more risk factors
CACP
- Chronic Diseases
- Hypertension
- Diabete Mellitus
- COPD
- Asthma
- Heart Failure means Diagnosis
- Heart Disease - Angina Pectoris
- Heart Disease - Other
- Mental Disorders (Some exclusions)
CACP
- Chronic Diseases
What is excluded:
- Tobacco
- Addictions - Alcohol
- Addictions - Drug other than alcohol
CACP
- Risk Factors
- Obesity (BMI more than 30)
- Tobacco
- Addictions - Alcohol
- Addictions - Drugs other than alcohol
CACP
- Fee
$100 every 365 days
- Is linked to patient’s ID
CACP
- Previous CACP
Must confirm patient has no CACP or SMMA, or any AHS funded similar services completed within the last 365 days
Must inquire if CACP or SMMA or Follow-ups or CCP have been previously completed
- Must also make best efforts to obtain a copy of that plan before creating own CACP
CACP
- Documentation
- Claim Code to speicfy if Clinical Pharmacist has APA or not
- Diagnostic Codes
- Complete CACP must be dated and signed by Pharmacist AND Patient/Representative
- Physician CCP and other CACPs
CACP
- Sending Information
Completed signed copy or a summary must be provided to:
- Patient
- Health Professionals Involved in Patient’s Care (Can also be requested by Health Care Professional involved in care)
CACP Follow Ups
- Requirements
Resident must have:
- Active CACP
- Complex Needs
- In-person / Telephone encounter with patient
- A reason for Follow Up
CACP Follow Ups
- Reasons
- Following instructions in the CACP (Follow up related)
OR - Patient has been discharged from an approved hospital in past 14 days
OR - Patient has been referred by Health Professional for a Follow Up
CACP Follow Up
- Documentation
- Claim Codes to specify if Pharmacist has APA or not
- Complete CACP follow up dated and signed by pharmacist
- Updated elements of CACP
- Completed signed copy / summary provided to the patient
- Completed signed copy / summary provided to health professionals involved with patient’s care
- Must be provided to health professional involved in patient’s care upon request
CACP Follow Up
- Fee
$20 per follow up
- Up to 4 in 365 days
Can charge total of $80 in 365 days
SMMA
- Definition
The preparation, documentation, and review of a care plan for an eligible resident
SMMA
- Requirements
- Chronic Condition + Taking 3 or more Schedule 1 drugs
OR - Diabetes + Taking 1 Schedule 1 or Insulin
OR - Tobacco Product daily + Willing to receive Tobacco Cessation Services
No SMMA or CACP or similar funded AHS services within last 365 days
SMMA
- Additional Services
SMMA (Tobacco Cessation) can be completed in addition to SMMA or CACP
SMMA
- Chronic Conditions
Hypertension
Diabetes
Asthma
COPD
Heart Failure means Diagnosis
Heart Disease - Angina Pectoris
Heart Disease - Other
Mental Disorders
SMMA
- Are Atorvastatin 40 mg and Atorvastatin 80 mg considered the same schedule 1 drug
No, different strengths are counted as the same drug
SMMA
- Previous Services
Have to check if CACP or SMMA or Follow-ups or CCP has been completed before
- Must make best efforts to obtain a copy of that plan before making SMMA
SMMA
- Documentation
- Claim Codes to specify if Pharmacist has APA or not
- Specify what type of SMMA
- Diagnostic Codes
- Complete SMMA dated and signed by pharmacist and patient
- Copy of Physician CCP and other SMMA/CACP
- All elements of SMMA
- Complete signed copy / summary provided to patient and health professionals involved in patient’s care
- Must provide to health care professional if requested
- All care plans must be retained by the pharmacy for 10 years
SMMA
- Different Types
- 3 Drugs
- Diabetes
- Smoking Cessation
SMMA
- Fees
- $60 every 365 days
- Tobacco SMMA can be completed in addition
SMMA Follow Ups
- Requirements
Active SMMA:
- Meet SMMA eligibility
- In person / telephone encounter with patient
- Following instructions in SMMA (related to follow up)
OR
Patient has been discharged from hospital in past 14 days
OR
Patient has been referred by health professional for follow up
SMMA Follow Ups
- Requirements Summary
Normal (In-person / Phone)
Hospital (Last 14 days)
Referral
SMMA Follow Up
- Fees
$20 up to 4 in 365 days
(Can do an additional 4 follow ups in 365 days related to Tobacco Cessation - So a possibility of 8 follow ups)
Assessment for Prescription Renewal
- Definition
Adapting an existing prescription for continuity of care (Schedule 1 / Blood Product)
Assessment for Prescription Renewal
- Documendation
- Claim Code to specify Pharmacist with or without APA
- Copy of original prescription
- Name and address of where service was performed
- Record of notice notifying the health care professional on the service performed
Assessment for Prescription Renewal
- Fees
$20
Assessment for Adaptation of a Prescription or Alteration of an Insulin Order
- Definition
Must be a schedule 1 drug or insulin
- Alteration of dose or regiment OR
- Therapeutic substitution OR
- Discontinuation due to little benefit or excessive harm
Does not include:
- Generic Substitution
- Altering the formulation of insulin
Assessment for Adaptation of a Prescription or Alteration of an Insulin Order
- Documentation
- Claim Code specifies clinical pharmacist with or without APA
- Copy of original prescription
- Name and address of where the service was performed
- Record of notice to other health care professional about service
Assessment for Adaptation of a Prescription or Alteration of an Insulin Order
- Fees
$20
Assessment for Prescribing at Initial Access or Prescribing to Manage Ongoing Therapy
- Definition
- Must have Additional Prescribing Authority
- Must be schedule 1 drug or blood product
- Must be pharmacist’s own assessment of resident
Assessment for Prescribing at Initial Access or Prescribing to Manage Ongoing Therapy
- Documentation
- Claim Code specifies clinical pharmacist with APA
- Copy of original prescription
- Name and address of where service was performed
- Record of notice to health care professional about service
Assessment for Prescribing at Initial Access or Prescribing to Manage Ongoing Therapy
- Fee
$25
Fee not payable if:
- Pharmacist received recommendation from another Health Professional who could have prescribed the schedule 1 drug / blood product
- Pharmacist determined with another Health Professional that a schedule 1 drug / blood product is appropriate for resident
Assessment to Prescribe in an Emergency
- Definition
- Must be schedule 1 or blood product
- Must be an immediate need for drug therapy
- Not reasonable to see another prescriber
Assessment to Prescribe in an Emergency
- Documentation
- Claim Code specifies clinical pharmacist with or without APA
- Copy of original prescription
- Name and address of where service was performed
- Record of notice to other health care professionals about service
Assessment to Prescribe in an Emergency
- Fee
$20
Assessment for Ensuring Continuity of Care in a State of Emergency
- Definition
- Must be schedule 1 drug or blood product
- Ends when emergency ends
Assessment for Ensuring Continuity of Care in a State of Emergency
- Documentation
- Claim Code specifies clinical pharmacist with or without APA
- Copy of original prescription
- Name and address of where service was performed
- Record of notice to other health care professionals about service
Assessment for Ensuring Continuity of Care in a State of Emergency
- Fees
$20
Assessment to Refuse to Fill a Prescription
- Definition
Refusal to fill a prescription based on
- Potential overuse/abuse
- Falsified or altered prescription
Does not apply:
- Based on pharmacist’s moral/personal reasons
- Based on resident’s request for an early refill
Assessment to Refuse to Fill a Prescription
- Documentation
- Claim Code specifies clinical pharmacist with or without APA
- Copy of original prescription
- Name and address of where service was performed
- Record of notice to other health care professionals about service
Assessment to Refuse to Fill a Prescription
- Fees
$20
Assessment for a Trial Prescription
- Definition
Trial Prescription:
- Reduced quantity of a newly prescribed drug before balance quantity is dispensed
- Used to assess patient’s response / tolerance
Assessment for a Trial Prescription
- Documentation
Special Service Code:
- First Claim: Trial Initiated
- Second Claim: Not tolerated or Trial OK
- Claim Code specifies clinical pharmacist with or without APA
- Copy of original prescription
- Name and address of where service was performed
- Record of notice to other health care professionals about service
Assessment for a Trial Prescription
- Fees
$0 initiation
$20 (follow-up and decision)
Assessment for Administration of a Product by Injection
- Definition
- Pharmacist must have injection authority
- Resident must be 5 years or older
Product must be on:
- Alberta Drug Benefit List OR
- Alberta Human Services Drug Benefit Supplement OR
- Palliative Coverage Drug Benefit Supplement
Assessment for Administration of a Product by Injection
- Fees
Claims limited to 2 per day per resident
- Limit of 2 does not include publicly funded vaccines
- Can be done even if another service was billed on the same day
$20
Assessment for Administration of a Product by Injection
- Documentation
- Claim Code specifies clinical pharmacist with or without APA
- Copy of original prescription
- Name and address of where service was performed
- Record of notice to other health care professionals about service
Assessment for Administration of a Publicly Funded Vaccine
- Definition
- Resident must qualify per the Alberta Health Immunization Program
- Must be vaccine procured from Alberta Health Immunization Program (no private stock)
- Pharmacist must have injection authority (not needed for intranasal vaccine sprays)
- Pharmacist must have training as required by the Alberta Health Immunization Program
Assessment for Administration of a Publicly Funded Vaccine
- Documentation
- Vaccine administration information as required by the Alberta Health Immunization Program
- Copy of original prescription
- Name and address of where service was performed
- Record of notice to other health care professionals about service
Assessment for Administration of a Publicly Funded Vaccine
- Fees
$13
Greenshield Canada
- Compensation Programs
Health Coaching
- Cardiovascular
- Smoking Cessation
Deprescribing
- PPI
- Benzodiazepine
Pharmacogenomic testing and counseling
Health Care Spending Accounts
Criteria depends on service, is optional
Minimum Criteria: Eligible medical expense
