"Wow, that is insane that they ask for the patient’s progress report. As if it wasn’t bad enough that the government has any right to look at this (HIPAA apparently doesn’t apply to the state), they then treat the patient like a middle schooler; a progress report?!?!?!?! Than, to top it all of, they ask the wrong guy for the information.
Question: when you say a retail pharmacy, does that mean you own a building that is simply a pharmacy and that is all? When you first said it, I pictured a CVS or something."
When I say retail pharmacy I mean an outpatient pharmacy that sells prescriptions to the public. I work for a large retail store that has a pharmacy inside with thousands of locations.
Let me clarify a few things in regards to Medicare and prescriptions. There are 2 plans, Medicare Part D that Bush enacted, and Medicare Part B. Part D is used when purchasing drugs and is actually carried out by private insurance companies that are subsidized by the government. Part B is used to pay for medical devices (diabetic testing strips, nebulizers, wheelchairs…). Part B is paid directly from the governement, not using private insurers as a middleman. The audits I am talking about are for Part B. Luckily, the majority of my business is Part D (even though that presents it’s own set of problems).
Let me give another scenario though in regards to Part B. If you are a diabetic and require daily testing of your blood sugar, you are allowed to test 1 time per day if you are not on insulin, and 3 times per day if you are on insulin. Some people actually require testing of 6 or 8 times a day though, so then what? Don’t worry, Medicare has an override for this…all you have to do is keep a daily testing log, and then every time you need a refill bring that log in and let me fax the results off to the Medicare gods for approval. Keep in mind, we are mostly dealing with elderly patients here. Can they accurately keep a log of their blood sugar if they are testing 6 times a day? It’s not like they can’t just make up numbers anyway, I don’t know what the point of this even is.
As for the prescription itself, it has very strict criteria that must be on it. Dr. forgot to write the diagnosis code on the Rx? Sorry, go home, I will fax the Rx back to the Dr. so he can scribble a few numbers on it. No diagnosis code on your albuterol Rx, sorry, go home while I fax this to your Dr. Hopefully it’s not Friday night or you may have to wait until Monday. Please don’t have an asthma attack between now and then. And no, I can’t just call the Dr. to get the diagnosis code, he physically has to write it on the Rx.
But what about inpatient pharmacy, what my wife does? As I said before, October 1st was a new deadline for some new rules under Obamacare. One of those regulations involves how often a patient is readmitted into a hospital over a 30 day period. If some patient gets discharged and has to return within 30 days, the Medicare reimbursement gets decreased to the hospital.
But how much of this does the hospital have control over? Heart failure patients, for example, are continuously in and out of the hospital. Because their heart is weak, they have fluid build-up on their lungs and they can’t breath easily. Now a lot of this can be controlled by medications. But what if the patient doesn’t take the meds? What if they choose not to follow dietary guidelines? The hospital can do everything within their power to prevent this, but at the end of the day we can’t force the meds down the patient’s throat. The hospital gets penalized for the lack of patient responsibility.
