In this month’s blog entry, Change Healthcare’s Deborah Roberts offers tips for pharmacies on how to prepare for and get through a Medicare Part B audit.
Healthcare IT by Change Healthcare
Industry groups are increasingly recognizing the role of effective medication management in achieving clinical benefits and improved costs — particularly medication adherence and the rising cost of generic and brand name drugs.
"The United States is in the midst of a prescription drug abuse epidemic as addiction, overdoses and deaths associated with non-medical drug use have risen dramatically over the last decade. In 2009, U.S. drug overdose deaths outnumbered motor vehicle accident deaths for the first time," writes Wendy Cloe, a director at Emdeon, in her latest blog.
"The diabetic is a critically important patient for pharmacies to serve. Yet, with increased Medicare audits, stringent compliance requirements and reduced reimbursements, is servicing these patients really worth it?" writes Kevin Dore, a director at Emdeon, in his latest blog.
"I remember the first time I worked in a pharmacy like it was yesterday. Not only was it fast paced and exhilarating, the work was also meaningful and beneficial to the community. I can hardly believe it’s been close to 20 years since I began behind the counter," writes Jonathon Kopf, pharmacy product manager for Emdeon, in his latest blog post.
"You may have heard the good news: through proactive involvement from pharmacists all across the state, California recently passed a law (SB 493 in October, 2013) declaring that pharmacists are healthcare providers who have the authority to provide healthcare services within the state. The law creates a new category of pharmacists by statute, for those who meet the criteria, and as a result creates new opportunities for pharmacists to engage with others more traditionally understood as healthcare providers to assist patients in managing chronic conditions," writes Nathan Ludvigson, director, government business development at Emdeon.
The healthcare industry has always had its fair share of buzz words and the pharmacy sector is no exception, said Emdeon's Kevin Mahoney. Medication synchronization, outcomes, clinical services, medication therapy management, accountable care organizations… our conferences and publications are full of experts discussing how pharmacies can successfully participate in these new opportunities. What I find to be so interesting in this new crop of go-to phrases is they all really boil down to one common element and that is patient care.
As I look around my part of the country, I can’t help but notice that leaves are starting to change colors, football fans of all flavors are gearing up for competition and pharmacies are stocked up with flu vaccine – ready to begin administration of the annual flu shots.
Emdeon's Gene Boerger said pharmacies are busily expanding into providing medical services, including providing basic healthcare screenings and immunization services. As a result, they are becoming healthcare providers, over and above their traditional roles. But just how well they are able to integrate within the healthcare continuum over the long term depends upon the strength of the bonds they are able to build with payers and medical providers … and those relationships are rooted in data connectivity.
The healthcare industry continues to prepare for ACA implementation and the expected influx of newly eligible patients, said Emdeon's Kevin Mahoney. Many pharmacies are changing their staffing models in preparation for customers with expanded Medicaid benefits — especially as we approach the New Year. This is a good time for me to remind you to be thinking about your eligibility program.