Resident prescribing meds for family members

[needachange2017]

Hey guys,

Thought I consult you folks on a issue that I've been getting different responses from seniors.
I am a second year radiology resident; I have my own npi number. From what I gather, many of my colleagues are calling in prescriptions for abx, ibuprofen, scopolomine, etc, no narcs or controls. So I tried doing the same for my family the other day. When I called in to the CVS my family goes to, everything seemed fine. ez peezy lemon squeezy, right? No, couple days later, I get a email saying I'm not registered under CMS (my dad is under medicaid), and that I would get no refills for the ibuprofen 600mg that I called in for.

So whats the deal guys? Is it kosher for residents to call in scripts for family members as long as it's not a control? what's this business with CMS?

thanks for the help.

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[lord999]

http://forums.studentdoctor.net/thr...ur-states-policy-your-educated-stance.631760/

There's already an active thread on this, so I guess you're from a state that doesn't have that restriction as a problem or has extremely lazy pharmacists. On the CMS matter, that's actually not a prescription issue, but an insurance one. I'm betting that when the script was submitted, the insurance check confirmed that you are not registered with CMS as an independent provider at the moment and rejects payment. Depending on your state's licensing status, this is either very easy to rectify or a PITA. Note that from a radiologist and not related to practice, it could be a later problem for you if there is an insurance audit and this script comes up. If discovered to be paid and without corresponding charting, that's a huge utilization review penalty to your supervising physician's reimbursement percentage which that physician may take out on you professionally.

 

[SELDANE]

Whether you are in a residency program or not has no bearing on the situation. To my knowledge as long as you have active medical license you are free to prescribe to whomever you like. If you have an active DEA or BNDD number the same applies to controlled substances. Unless there is some state law preventing self prescribing or prescribing to family members I see no problem.

 

[zelman]

Whether you are in a residency program or not has no bearing on the situation. To my knowledge as long as you have active medical license you are free to prescribe to whomever you like. If you have an active DEA or BNDD number the same applies to controlled substances. Unless there is some state law preventing self prescribing or prescribing to family members I see no problem.

You can only prescribe medication to your patients, and that requires a specific type of relationship. If I call a provider's practice and ask for a patient's weight and it turns out they don't have a chart or medical record, the prescription is invalid as far as I'm concerned.

 

[zelman]

A provider cab write fit friends and family as long as they keep medical records. They don't have to see them in their office.

Okay, so if I call a provider's practice and ask for a patient's weight and it turns out they don't have a chart or medical record, and then I ask if they practice medicine elsewhere, and am told that they don't, then the prescription is invalid as far as I'm concerned.

 

[SELDANE]

You can only prescribe medication to your patients, and that requires a specific type of relationship. If I call a provider's practice and ask for a patient's weight and it turns out they don't have a chart or medical record, the prescription is invalid as far as I'm concerned.

So a prescriber needs to keep records to your liking? Hmmm. That seems a bit subjective. If your employer allows you such leeway then good for you.

 

[needachange2017]

so the consensus is ok to call in scripts for my parents...thanks

 

[gwarm01]

So a prescriber needs to keep records to your liking? Hmmm. That seems a bit subjective. If your employer allows you such leeway then good for you.

A pharmacist has the right and legal responsibility to reject any prescription they deem to be illegitimate. You may not agree with the criteria he has set, but it is well within his authority to do so. An employer cannot force a pharmacist to dispense an illegitimate prescription.

 

[SELDANE]

so the consensus is ok to call in scripts for my parents...thanks

As long as you have a valid medical license legally you are well within your rights to call in prescriptions as you see fit.

 

[SELDANE]

A pharmacist has the right and legal responsibility to reject any prescription they deem to be illegitimate. You may not agree with the criteria he has set, but it is well within his authority to do so. An employer cannot force a pharmacist to dispense an illegitimate prescription.

All I did was simply answer a question about whether someone with a medical license had a legal right to write a prescription for someone they defined as a patient. I never questioned whether or not you had to right to fill it or not. I do question whether your employer is comfortable with your subjective criteria for defining what is or isn't a valid prescription.

 

[owlegrad]

Keeping records isn't exactly a subjective criteria...

 

[zelman]

So a prescriber needs to keep records to your liking? Hmmm. That seems a bit subjective. If your employer allows you such leeway then good for you.

If they've never weighed the patient, they haven't examined them. It's a simple and straightforward way to ask if there has been an exam and is actually pertinent to the dosing of many drugs.

 

[SELDANE]

If they've never weighed the patient, they haven't examined them. It's a simple and straightforward way to ask if there has been an exam and is actually pertinent to the dosing of many drugs.

Were not talking about hanging vancomycin in the garage. Certainly you have more important things to do than go off on goose chases about MD/patient relationships regarding Motrin, Zpak(s) and scopolamine.

 

[VA Hopeful Dr]

If they've never weighed the patient, they haven't examined them. It's a simple and straightforward way to ask if there has been an exam and is actually pertinent to the dosing of many drugs.

Bullpoop. I often see patients in my office without weighing them frequently.

 

[lord999]

Bullpoop. I often see patients in my office without weighing them frequently.

I don't think zelman referred to an absolute recent weight, just that there is one. Well, not to make an ad hominem attack, but hope for your sake that you don't practice like that in the VA. Almost all the standards at the state level and the one for the federal require that to make a visit, you have to have form a CMS-1500 form. Now, it doesn't require a current weight (if you're treating adults), but you'd easily fail utilization review audit if you don't have one at all for a patient as it's a fundamental vital sign. (If you're treating pediatrics and don't have a recent weight and height (in the last week or so), that's going to immediately fail UR.) Why I use UR as the convening example is that for most Boards, that's the standard they use.

In the VA for a practitioner who doesn't maintain a reasonable set of vitals on the patient (and considering that it's highly unlikely that you'd have to do it yourself as you can assign the RN's or MA's to do it), it's both something that Business Compliance and/or Quality Management would dock you on, and $30k performance pay is kind of enough to get most physicians to get with the program.

On the original case, I again highly doubt it's a licensing issue, he or she is free to prescribe if the state allows and the license is unrestricted, it's probably for some stupid non-clinical bureaucratic registration matter that ties up the prescription. But, that's what trips you up, and it's quite frustrating as no one actually teaches you how to deal with health care financing and bureaucracy until you get cheated your on your first contract.

 

[VA Hopeful Dr]

I don't think zelman referred to an absolute recent weight, just that there is one. Well, not to make an ad hominem attack, but hope for your sake that you don't practice like that in the VA. Almost all the standards at the state level and the one for the federal require that to make a visit, you have to have form a CMS-1500 form. Now, it doesn't require a current weight (if you're treating adults), but you'd easily fail utilization review audit if you don't have one at all for a patient as it's a fundamental vital sign. (If you're treating pediatrics and don't have a recent weight and height (in the last week or so), that's going to immediately fail UR.) Why I use UR as the convening example is that for most Boards, that's the standard they use.

In the VA for a practitioner who doesn't maintain a reasonable set of vitals on the patient (and considering that it's highly unlikely that you'd have to do it yourself as you can assign the RN's or MA's to do it), it's both something that Business Compliance and/or Quality Management would dock you on, and $30k performance pay is kind of enough to get most physicians to get with the program.

On the original case, I again highly doubt it's a licensing issue, he or she is free to prescribe if the state allows and the license is unrestricted, it's probably for some stupid non-clinical bureaucratic registration matter that ties up the prescription. But, that's what trips you up, and it's quite frustrating as no one actually teaches you how to deal with health care financing and bureaucracy until you get cheated your on your first contract.

I don't work for the VA so no worries there

 

[zelman]

Bullpoop. I often see patients in my office without weighing them frequently.

You you have any piece of paper (or electronic equivalent) with their weight documented, ever?

 

[ldiot]

Did you not read the email? You are not registered under CMS so they can't bill medicaid. It has nothing to do with the fact that they are a family member.

That being said, as others have pointed out, be certain to keep record of what you prescribed even if it's a family member. Not having records can land you in trouble whether or not it's family.

 

[VA Hopeful Dr]

You you have any piece of paper (or electronic equivalent) with their weight documented, ever?

Depends on if they have ever had a visit when my MA is in the office. If no, then I likely have not weighed them (I never do it, she always does).

 

[DrNyvia]

Adding onto the whole family/self-prescribing thing, it is legal. It's just not ethical. Don't be surprised if a pharmacist rejects the fill because of ethical reasons, but don't be surprised if a pharmacist fills the script because it technically is legal. This sounds like an insurance coverage + your registration title issue, not a family/self-prescribing issue.

 

[BenJammin]

As long as you have a valid medical license legally you are well within your rights to call in prescriptions as you see fit.

Prescriptions in most states are only valid pursuant to a patient-physician relationship. No relationship?

Depends on if they have ever had a visit when my MA is in the office. If no, then I likely have not weighed them (I never do it, she always does).

Can you prove a valid patient-physician relationship? If not, those prescriptions are null and void.

 

[trailerpark]

I'm sure she does. Evertime I go to the doctors they weigh me first thing.


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[VA Hopeful Dr]

Can you prove a valid patient-physician relationship? If not, those prescriptions are null and void.

Easily, that's what office notes are for.

 

[BidingMyTime]

So whats the deal guys? Is it kosher for residents to call in scripts for family members as long as it's not a control? what's this business with CMS?

As others have pointed out, whether or not a physician can legally write for a prescription, has nothing to do with whether or not insurance (including medicaid or medicare) will pay for that prescription. Many insurances won't pay for prescriptions written by a doctor or institution that they don't have a contract with.

All I did was simply answer a question about whether someone with a medical license had a legal right to write a prescription for someone they defined as a patient. I never questioned whether or not you had to right to fill it or not. I do question whether your employer is comfortable with your subjective criteria for defining what is or isn't a valid prescription.

Employers don't like when payments are reversed on prescriptions, from auditing. If a prescription is audited, and the insurance determines there was not a physician-patient relationship, then the prescription is considered invalid and payment will be reversed. Maybe even with a penalty. So yes, employers want their employees to turn down non-legitimate prescriptions, as there can be a great financial loss occured on filling a non-valid prescription (depending on the prescription.)