Which would cause us to call back and say that phone-in orders are not valid for Medicare B diabetes supply claims. We would explain that we needed a hand-written or fax order that had:
- the patient name
- the product(s) being ordered
- the quantity to be dispensed
- the testing frequency
- refill information
- and the ICD coding appropriate for the patient's condition
This went on for months. Patients were receiving substandard care because some nurse was having what she believed to be a turf issue. The last thing I want to do is keep a patient from being able to test their blood glucose levels, but I'm not going to circumvent the regulations that are in place.
I think it finally came down to one patient who was able to get the physician's attention on this matter. The patient asked me what I would do if I were in their shoes. I told them that if my physician wasn't willing to provide a valid prescription for my testing supplies, I would assume that they really didn't care about my condition and that I would change physicians. I handed the patient a leaflet that said what was required on the Medicare B prescriptions. The patient was on their way to the physician's office. I don't know the details of the conversation, but whenever we call now, we get what we need from that office.
We could have just fudged the information in the computer. Hope that we wouldn't get audited. Take care of the patient and not really worry about it. Good thing we didn't because...
We've been receiving Medicare B requests for additional information fairly regularly over the last few months. It's not too big of an issue because we follow the rules.
Most of the requests are for copies of the original prescriptions and signatures showing that they were picked up. That takes about five minutes to get together.
But then they want the pharmacy to provide copies of the testing logs and physician progress notes. That's a bit more time-consuming. Especially getting the physician notes. But we do it. And get it back to Medicare by the due date (which isn't too long).
The audit process wastes pharmacist time. Diverts pharmacist attention.
It makes me wonder if my pharmacy is being singled out, or are all Medicare B suppliers getting hit with audit requests. Given that Medicare has been burned by some of the fly-by-night businesses that bill for a couple million dollars of prosthetics, collect payment, then close up shop I can partially see the reason for auditing. But we only bill about 10 claims per week, and we have been doing this for years. It's not like we've suddenly quintupled the number of claims that we are submitting.
It also makes me wonder if Wilford Brimley and the folks over at Liberty Medical are being served with a proportionate amount of audits. Especially since I have had patients come in and tell me that they have over 1200 diabeetus test strips on hand because Liberty won't stop sending them.