Completion fill, which rph is at fault?

[Curiousone1111]

Rph 2 bears no responsibility. Ridiculous to suggest otherwise.

Some people claim you still let it out the door on your watch so you’re responsible since you physically bagged the remainder lol

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[Curiousone1111]

I never really feel like it is a matter of who did what. It's more like who is lower on the totem pole. As long as I know that I am the low hanging fruit, I'll be extra vigilant on anything that even remotely has my name on it.

@Sabril at independents, they dont have that verification for completions like chains do where your initials will be there. For example, today I may bill a medication and put it on order for tomorrow, leave the label on the counter, and pray that tomorrow’s Rph doesn’t misfill. The label has my initials on it so I’m always paranoid about that, but that was essentially what I was asking about…. If I’m filling in for the day and just have to bag a medication that was billed and basically approved by a pharmacist yesterday, do i just bag it without checking ddi’s or do I still treat it as if I’m filling it myself? My initials wont be on anything but I was there for that day.

 

[Sabril]

If the label is there ready to fill, then it is expected that the one who made such label available did two things: making sure that the label is typed in correctly per prescription, and resolved whatever DUR there was. Your job the next day is to make sure the med is filled correctly per label and consultation if the patient comes in.

Not specially to this instance however, be extra careful when you work for independent, especially those places with loose rules and low individual accountability. It's all fine and dandy but when things go down, it is not the ones who did wrong but whoever the boss can grab at that moment that has to fix things up.

 

[Curiousone1111]

If the label is there ready to fill, then it is expected that the one who made such label available did two things: making sure that the label is typed in correctly per prescription, and resolved whatever DUR there was. Your job the next day is to make sure the med is filled correctly per label and consultation if the patient comes in.

Not specially to this instance however, be extra careful when you work for independent, especially those places with loose rules and low individual accountability. It's all fine and dandy but when things go down, it is not the ones who did wrong but whoever the boss can grab at that moment that has to fix things up.

@Sabril I figured the same… I’m not consistent, I’m just filling in at random places, but since independents don’t have as many safeguards in as chains, that’s why I get a bit worried about leaving the label for next day rph to fill. I’m always paranoid they’ll fill it wrong and my name on the label will trace back to me… but also feel they’ll hate me if I unbill and shred the label before leaving 😂

 

[Sabril]

If you are a fill in, then don't worry too much. The PIC at each place is ultimately the one who has to be responsible for whatever mishap that goes down. No one is gonna go after a guy who is only there once in a blue moon.

And they may hate you but not for too long as long as you are cheap enough labor.

 

[Curiousone1111]

If you are a fill in, then don't worry too much. The PIC at each place is ultimately the one who has to be responsible for whatever mishap that goes down. No one is gonna go after a guy who is only there once in a blue moon.

And they may hate you but not for too long as long as you are cheap enough labor.

@Sabril I used to be PIC, but I didn’t think I’d be responsible for another rph’s mistake

 

[Sparda29]

@Sabril at independents, they dont have that verification for completions like chains do where your initials will be there. For example, today I may bill a medication and put it on order for tomorrow, leave the label on the counter, and pray that tomorrow’s Rph doesn’t misfill. The label has my initials on it so I’m always paranoid about that, but that was essentially what I was asking about…. If I’m filling in for the day and just have to bag a medication that was billed and basically approved by a pharmacist yesterday, do i just bag it without checking ddi’s or do I still treat it as if I’m filling it myself? My initials wont be on anything but I was there for that day.

Supposed to reverse it, and rebill it the day it was received and put new initials on it.

 

[Curiousone1111]

Supposed to reverse it, and rebill it the day it was received and put new initials on it.

@Sparda29 yeah for full quantities of meds that would make sense or at least verify it to make sure its ok before it leaves the door… but if yesterday’s rph billed 30 pills and gave 15 out and now I have to give the remaining 15, it’s already billed as the 30 from yesterday. I don’t think it gets rebilled.

 

[wagrxm2000]

@Sparda29 yeah for full quantities of meds that would make sense or at least verify it to make sure its ok before it leaves the door… but if yesterday’s rph billed 30 pills and gave 15 out and now I have to give the remaining 15, it’s already billed as the 30 from yesterday. I don’t think it gets rebilled.

Independents apparently do whatever they want

Why are you billing 30 and giving 15?

 

[Sparda29]

Independents apparently do whatever they want

Why are you billing 30 and giving 15?

How do chains work with OOS/partial fills? Does the system bill the insurance when the partial fill is done or only when the complete fill is done?

In the case of billing for 30 then finding out you only have 15 in stock and ordering more then giving the rest the next day, that's done to make sure the claim is captured and then they can't run off and fill it somewhere else.

How do chains do vacation supplies for 2-3 month vacations when the insurance only covers 1 month at a time?

We usually just front them the 2-3 month supply and have the refill sitting there unbilled at the future date in the system with a note that it was already dispensed and to make sure to bill it and scan it out as picked up.

Do the chains just tell the patient that they have to pay cash if they want the vacation supply? I mentioned my above system to a interviewer when I applied for CVS and the guy got pissed off and said that was "insurance fraud" and ended the interview.

 

[Sine Cura]

Example:

"refugee" from Afghanistan is planning to travel to Afghanistan (um, why) but Medicaid covers max 1 month supply of Malarone.

LOL GTFO I don't give 2 ****s about your 3-month travel.

Getting paid for services not rendered or product not provided is considered fraud

 

[WorthlessOxygen]

How do chains work with OOS/partial fills? Does the system bill the insurance when the partial fill is done or only when the complete fill is done?

Only when it's completed. If not completed in a certain time, they will just bill for the initial supply.

Do the chains just tell the patient that they have to pay cash if they want the vacation supply?

Yes. Could also call the insurance for an override or offer to transfer to a local pharmacy that the patient can pick up while on vacation.

I mentioned my above system to a interviewer when I applied for CVS and the guy got pissed off and said that was "insurance fraud" and ended the interview.

Not sure what the quotes are for, billing for products not dispensed is a pretty clear case of insurance fraud.

 

[PharFromNormal]

Rph 2 bears no responsibility. Ridiculous to suggest otherwise.

Responsibility and accountability are two different things.

 

[Sabril]

@Sabril I used to be PIC, but I didn’t think I’d be responsible for another rph’s mistake

If something bad ever happens you'll be surprised how stupidly and quickly the PIC gets dragged into the midst of things. At the very least you are almost always the one who has to write up the corrective action plan to the board.

In the case of billing for 30 then finding out you only have 15 in stock and ordering more then giving the rest the next day, that's done to make sure the claim is captured and then they can't run off and fill it somewhere else.

We usually just front them the 2-3 month supply and have the refill sitting there unbilled at the future date in the system with a note that it was already dispensed and to make sure to bill it and scan it out as picked up.

I do #1 but not #2. #1 is iffy but I don't see it being a clear violation of FWA. After all you have 14 days to deliver the entire product, whether you do it at once or in parts is up to you and the patient.

#2 really isn't your problem if the insurance doesn't override for x amount of days. Legality aside, two problems with the logistics: one is what if they're skirting the donut hole and their copay next month is significantly more than this month's-how would you go about collecting those copays? Two is how do you get the patient's signature for month 2 and 3?

 

[Sparda29]

Only when it's completed. If not completed in a certain time, they will just bill for the initial supply.

Yes. Could also call the insurance for an override or offer to transfer to a local pharmacy that the patient can pick up while on vacation.



Not sure what the quotes are for, billing for products not dispensed is a pretty clear case of insurance fraud.

Can't transfer it because they are travelling to Dominican Republic, Cuba, Puerto Rico, Pakistan, Russia, India, etc.

The product has already been dispensed. You are dispensing ahead of time and billing retroactively.

The insurance company is putting an unnecessary roadblock for patients to get their medications in these situations. As a healthcare provider, we shouldn't give a **** about the financial wellbeing of an insurance company.

 

[Sparda29]

If something bad ever happens you'll be surprised how stupidly and quickly the PIC gets dragged into the midst of things. At the very least you are almost always the one who has to write up the corrective action plan to the board.

I do #1 but not #2. #1 is iffy but I don't see it being a clear violation of FWA. After all you have 14 days to deliver the entire product, whether you do it at once or in parts is up to you and the patient.

#2 really isn't your problem if the insurance doesn't override for x amount of days. Legality aside, two problems with the logistics: one is what if they're skirting the donut hole and their copay next month is significantly more than this month's-how would you go about collecting those copays? Two is how do you get the patient's signature for month 2 and 3?

Mail a delivery slip to be signed to their house, usually a relative who is home signs it and sends it back.

We usually don't collect copays to begin with.

 

[Sine Cura]

I don't care about people going on an unnecessary international trip (how are they paying for that anyway?) in the middle of a global pandemic.

 

[Sparda29]

I don't care about people going on an unnecessary international trip (how are they paying for that anyway?) in the middle of a global pandemic.

They live there 25-50% of the year.

 

[WorthlessOxygen]

Mail a delivery slip to be signed to their house, usually a relative who is home signs it and sends it back.

That same relative can pick up their meds and send them to the patient.

Or if they're spending they much time abroad and don't like any of the other options, they should factor out of pocket medication costs as part of their travel budget.

 

[Sabril]

Mail a delivery slip to be signed to their house, usually a relative who is home signs it and sends it back.

We usually don't collect copays to begin with.

If I already break that many rules, may as well forge the patient's signatures myself and call it a day.

Not taking a stab at you, but I definitely won't tell this to an interviewer.

 

[Sparda29]

That same relative can pick up their meds and send them to the patient.

Or if they're spending they much time abroad and don't like any of the other options, they should factor out of pocket medication costs as part of their travel budget.

Might not get through customs via mail.

Lol no. The insurances should simply stop putting days supply limits on prescriptions. If a doc sends a script for a year supply, the insurance should cover it.

 

[Sine Cura]

"I lost my 3 month supply of Reyataz"

 

[projektreverb]

I never really feel like it is a matter of who did what. It's more like who is lower on the totem pole. As long as I know that I am the low hanging fruit, I'll be extra vigilant on anything that even remotely has my name on it.

We’re all low on the totem pole. Reality is, if they want us out, they’ll fabricate a reason to get us out.