How does your store handle Medicare Part B prescription paperwork?

[justjoe]

I'm confused about what I have to do documentation-wise to fill Part B scripts for meters, lancets, and strips. It seems that every store has a different way of handling these issues. Can someone who has done a lot of Part B audits help me with these questions? I've contacted Medicare but they are not much help.

I practice in North Dakota.

For diabetic supplies:

Are you allowed to clarify the type of meter/strips/lancets over the phone with the doctor/nurse? Does Medicare allow ANY changes to be given over the phone?

Do you require that the Dx code be written on the hardcopy by the doctor on all Part B prescriptions? If it is a refill prescription and we use the Dx code from a prior Rx, is that good enough or does the doctor need to write it on each one? I've been personally sending them back to the doctor for them to write the Dx codes on if they haven't done so because the Dx code may change over time depending on the patient.

Preliminary oral orders before you get a faxed/written/electronic Rx. Has anyone ever done this? The pharmacists I work with refuse to mess with this issue and require that an acceptable Rx is sent over.

Are Part B scripts good for 6 months or 1 year? Some pharmacists I have worked with say for diabetic supplies it is 6 months and some say 1 year.

Some pharmacies I have worked for require that the patient bring in their testing log and we have to either download the test results of the meter, or use the copy machine to copy their bloody testing book. Does anyone require this?

What is the proper process for filling an Rx for a glucose meter? I know that there is some kind of different paperwork that you need to fill out. My store just fills it like a normal Rx with no extra paperwork. How do your stores handle it?

For test strips and lancets: What day supply are you entering for these?

For patients not using insulin, normal utilization: #100 strips/lancets should be 90 days, correct?

For patients using insulin, normal utilization: #300 strips/lancets should be 90 days, correct?

How do you document high utilization?

Thank you for helping me answer these questions. I am currently working at an independent with an old-time owner pharmacist that is not any help with insurance issues. He doesn't even know how to do the DUR override codes, etc.

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[trailerpark]

If it's Medicare Part B and it's an e-script I just make sure it has a diagnosis code on it and specific directions for use (no use as directed). If's its faxed then I also make sure the provider signs and dates his signature in addition to the dx code (written by provider!) and specific instructions for use. That's it. Refills are based on the original rx so no new dx code needed... New rx needs what I mentioned already. 6 months. For days supply get specific directions for use... We always urge doctors to write something like "dispense meter, strips, lancets covered by pt's insurance." They usually do. If a patient ever brought me his testing log I would laugh, he should be sending that to his insurance if they require it. I'm not going to do shiiiiit with it.

 

[ApricotVanilla]

So for a faxed med B rx, does the prescriber have to hand-write the date next to their signature? Or is a normal date printed or written near the top of the rx okay? RecentOh I heard a horror story of a pharmacy who got audited by Medicare and apparently their Rx's had everything except the date was not directly beside the prescribers name so they lost money on all those prescriptions? I can't tell if this is being exaggerated or even true at all but I wanted to ask because that's kind of concerning- as I was not aware of this rule and am 100% sure that none of my prescriptions have been following it....

 

[ldiot]

This is the federal government's idea of going after waste, fraud, and abuse. Screw pharmacists over stupid crap. I know the chain pharmacies take a net loss on part B. It's a complete joke.

 

[SmallCapPharma]

I have some additional questions for this topic.

If a script is faxed over with no dx code. Can we contact the Dr and write the Dx code on the script and just document who we spoke with/date/initial? Or do we need a new script faxed over?

If the original script has ICD-9 dx code and now we are refilling it, but ICD-10 codes are out now, can we convert the ICD-9 to the ICD-10 ourselves (there are books/apps for this) or do we need a new script?



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[wagrxm2000]

You barely get reimbursed and lose money on every medicare test strip so it really doesn't matter if you get audited. Taking $5 on $100 box of strips means nothing. It's why Walgreens wants us to make sure we do other scripts for those patients.

 

[zelman]

Regarding this...

Are you allowed to clarify the type of meter/strips/lancets over the phone with the doctor/nurse? Does Medicare allow ANY changes to be given over the phone?

Do you require that the Dx code be written on the hardcopy by the doctor on all Part B prescriptions? If it is a refill prescription and we use the Dx code from a prior Rx, is that good enough or does the doctor need to write it on each one? I've been personally sending them back to the doctor for them to write the Dx codes on if they haven't done so because the Dx code may change over time depending on the patient.

...and this...

I have some additional questions for this topic.

If a script is faxed over with no dx code. Can we contact the Dr and write the Dx code on the script and just document who we spoke with/date/initial? Or do we need a new script faxed over?

...note the following:

Need a new faxed or written prescription. Medicare does not believe in verbal prescriptions, transferred prescriptions, unicorns, verbal clarifications or leprechauns.

 

[LongPigeon]

I want to tag along a question. I don't bill part B very often, so I'm always confused about it. I tried billing glucometer, test strips and lancets under a patient's part D plan today and the claim actually went through ($0 copay for patient). I thought diabetic DME has to go under part B. But if part D pays for it, can I not just bill under part D and save the paperwork? Thanks!

 

[zelman]

I want to tag along a question. I don't bill part B very often, so I'm always confused about it. I tried billing glucometer, test strips and lancets under a patient's part D plan today and the claim actually went through ($0 copay for patient). I thought diabetic DME has to go under part B. But if part D pays for it, can I not just bill under part D and save the paperwork? Thanks!

That person has Part C. It looks like a part D plan when you bill it, but has different coverage.

 

[LongPigeon]

That person has Part C. It looks like a part D plan when you bill it, but has different coverage.

Zelman, would you mind elaborating on that? The plan shows up a PDP-D in our system. I've never heard of part C before, is it like a supplemental plan? Thanks!

 

[Ackj]

Zelman, would you mind elaborating on that? The plan shows up a PDP-D in our system. I've never heard of part C before, is it like a supplemental plan? Thanks!

In my experience, there's really no way to know upfront. We usually bill their standard insurance card first (Caremark, Express Scripts, whatever) and if it rejects, then move on to the part B. Many of them go through, and it saves all of the hassle of part B.

 

[zelman]

Zelman, would you mind elaborating on that? The plan shows up a PDP-D in our system. I've never heard of part C before, is it like a supplemental plan? Thanks!

Part C is an HMO plan, so it covers everything. Insurers get a fixed amount to cover all of a patient's medical costs (less copays and whatnot).

 

[cj98]

We get a lot of scripts for diabetic testing supplies at my store but a lot of the time the scripts are missing info required for part b. One of the pharmacist made a standard form with all the required info on a word document that's easy to read and lets the provider fill out the necessary info. We then use that as our new hardcopy. It makes things so much easier

 

[LongPigeon]

Thanks everyone for clarifying up part C.

 

[VeeSee]

Have to go through hell just to get it covered

 

[trailerpark]

As long as it's an E script and has the diagnosis code on it, what's the problem...?


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