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Medication Reconciliation Frequently Asked Questions (FAQ)
What is medication reconciliation?
Medication reconciliation is a review in which discharge medications are reconciled with the most recent medication list in the outpatient medical record.
Why is medication reconciliation important?
Medication reconciliation is done to reduce hospital readmissions by preventing medication errors such as omissions, duplications, dosing errors, or drug interactions.
Any medication issues identified require communication with the primary care provider and county case manager (if assigned) to ensure the issue is resolved.
Who is qualified to complete the Medication Reconciliation tool?
The following types of providers are qualified to perform medication reconciliation:
- Registered nurse (RN)
- Clinical pharmacist
- Prescribing provider
How long do I have to complete the medication reconciliation?
Providers have four days to compare current medications to discharge medications to ensure they match after a hospital inpatient discharge or a Skilled Nursing Facility (SNF) discharge. This also includes educating the member.
Does the member need to see a doctor after their discharge or SNF inpatient stay?
Yes. Medication reconciliation includes ensuring the member sees a primary care provider within 5 – 7 business days after inpatient or SNF discharge.
When can I bill for medication reconciliation?
Providers must complete the Medication Reconciliation Tool via the PrimeWest Health provider portal and submit the claim to PrimeWest Health within 10 days of comparing the medications and educating the member.
How do I bill for medication reconciliation?
PrimeWest Health reimburses medication reconciliation once per inpatient discharge, with reimbursement including payment for all necessary efforts to ensure the medication reconciliation is complete. Qualified providers must submit claims to PrimeWest Health in the 837P format using Current Procedural Terminology (CPT) Category II Code 1111F to indicate the service provided.
What should I do if I received notification on my remit, but I did not receive payment for performing the medication reconciliation?
If you are qualified to provide the medication reconciliation but did not receive payment, check to verify the following:
- Was the medication reconciliation completed within four days of an inpatient discharge?
- Was the Medication Reconciliation Tool completed and submitted to PrimeWest Health within 10 days of completion?
If each of these were completed correctly, please contact the PrimeWest Health Provider Contact Center at 1-866-431-0802 (toll free) for more information.
Can I provide medication reconciliation via telehealth during the COVID-19 peacetime emergency?
Yes. Providers must follow the steps above and use CPT Category II code 1111F and modifier 95 to indicate the service provided. Reimbursement for the CPT II code will be 60 percent of total due to the lack of an in-person home visit.
Updated_06/09/2020
