Sunday, November 9, 2008

Diabetic Testing Supplies

I think it's wonderful that Medicare covers test strips and lancets for diabetics. My only complaint is why do they have to have such strict prescription requirements. I fully understand the need to have specific directions, quantities, and a diagnosis code as to whether the patient requires insulin or not. I don't understand why pharmacists can't take that information over the phone.

Why can pharmacists accept a phoned in prescription for Vicodin or Lortab, but we need a hard copy (faxed or brought into us) in order to bill Medicare for test strips and lancets? Why are there no requirements like this for Medicaid? What makes Medicare different than Medicaid in this regard?

It's really just a giant pain in the ass, and it inconveniences both patients and doctors. What often happens is that the patient will call the pharmacy and use the telefill to ask for a refill on their test strips. Our, and many other pharmacies', telefill system will automatically fax the doctor a renewal request if the patient is out of refills. The doctor's office will get the request, and in a day or so, they'll fax the approval back to us.

This creates a problem because when we go to process the approved refill, we'll realize that the patient has Medicare. Therefore, we need to contact the doctor's office again for a new script that has all those wonderful Medicare requirements (specific product, quantity, directions, diagnosis code). Getting verbal confirmation over the phone simply isn't good enough, so we have to wait for the doctor to send the Medicare compliant prescription to us before we can fill it.

I just don't understand why all of this can't be accomplished with a phone call and the pharmacist documenting on the script the proper directions, quantity, and diagnosis code. Why does it have to be directly from the prescriber? Like I said, if we can get verbal confirmation of a Vicodin script, what's the harm in allowing it on a Medicare prescription? It's just a waste of time, in my opinion.


Anonymous said...

Not only that, but there is also a rule that was coming out for 2009 but will now be out 2012 where we cannot even take a FAX for it!


Anonymous said...

We have found that these requirements are coming from our DMERC clearinghouse and NOT Medicare. They are trying to prevent fraud, waste and abuse. I think if they want to prevent fraud they should look inside and can the person who watched billions of dollars for wheelchairs going to florida. Call your dmerc and demand they change their ways. If not send in a FORMAL complaint to CMS. We got a couple of these stupid edits reversed by complaining.

Anonymous said...

Your last sentence says it all...

"It's just a waste of time".

This is what governmental healthcare gets you...giant wastes of time. So all the 'paperwork' is in order. Thus, maybe eeking enough rejects out of the improperly processed prescritptions to pay the salaray of the auditor that comes to your store to fine the "improperly processed" prescriptions...vicious cycle of government setting up requirements to pay for more government with mroe requirements, etc. etc. etc. welfare state at its finest.

Anonymous said...

Well, now, I learned something today. First, in my agency work in two states, I'd never run into the issue of the physician written-out-only diabetes supplies, so I was curious as to what infraction I'd skirted. (One of the big issues to bar pharmacists from temp jobs is whether we've done insurance fraud, and I was a little nervous for a minute.) You'd think there'd be some notice letting you know if you're about to embark into a fraud situation. In many encounters with legalities, I've had to go with the fundamentals I learned in school in the state of original licensure, and try to figure out the 'intent' of the law.

My guess was that if there's an issue of a requirement of MD-written scripts, it's meant to cause a disruptive, discouraging hassle for those that want diabetic testing supplies as well as those pharmacists filling scripts--so that the business goes to DMG companies or mail-out programs. So, those only thrifty (and have time) enough to pursue the particulars will receive proper billing and reimbursement.

I would be inclined not to fault the Fed, for additional hassles, maybe states but certainly the insurance intermediaries, as I'm more and more convinced that that there are many capitalistic 'plots' (of insurance overseers i.e. those that set up insurance plans, and cahoots with 'big' business--see Pharmacy Chick's blog), to deliberately defraud the government, and ultimately tax-payers, and then blame it on the incoming administration, who hasn't even 'arrived'.