QS/1 Customers Discuss 19.1.6
Insight April â€™11
QS/1 Staying current with technology, legislative changes, and system updates is the business mantra in today’s healthcare environment. Maintaining knowledge in each area contributes to the success of your business. Technology offers the means to stay relevant and productive, but being proactive and downloading updates when notified aids in the effort to keep your system current with the enhanced capabilities to meet today’s demands. Over the years, QS/1 updates have evolved to combine faster download capacity with software capability to meet the continuous demands of the healthcare industry. Service Pack 19.1.6 is a perfect example of an upgrade package that offers a multitude of enhancements that distinguishes itself behind the scenes, offering system and behind the counter support, expanding business and customer services. Insight’s April feature highlights 19.1.6’s expansive enhancements, which include Pharmacy at a Glance, Will Call, SystemOne Notes, Customized Reports, as well as pharmacy and Point-of-Sale integration. While technology is the driving force behind a majority of healthcare workflow and business practices, legislation often represents a toll booth or speed bump. To smoothly navigate the twists and turns of these changes, QS/1 has increased its role in disseminating legislative information. We increased our Industry News section to three pages, continue to work closely with the Dumbarton Group and Associates who serve as legislative consultants and guest writers, and have increased our business editorial pages as well. In this issue, our editorials address audit survival and business partnership strategies. In 2010 major healthcare changes were legislated, and individuals working in the healthcare industry expect those changes to occur now through 2014. The software tools engineered at QS/1 are being designed to meet the challenges of tomorrow’s healthcare. The end result of staying current equals a successful business that works cohesively with up-to-date information. Sincerely,
Tammy Devine, President, QS/1
2 | Insight | April 2011
Industry News Hot Topics . . . . . . . Pg. 4
QS/1 Customers Discuss 19.1.6
contents MSM Takes into Account the Delicate Balancing Act Between Profit and Inventory
Audits – What’s Behind the Increase and How to Survive One Healthcare Legislation by The Book and Decoded . . . Pg. 8
Pharmacy & HME Audits . . . . . . . . . . . . . . . . Pg. 10
QS/1 Customers Discuss 19.1.6
Insight April ’11
QS/1 Customers Discuss 19.1.6 . . . Pg. 14
Industry News . . . Pg. 4
MSM Takes Into Account the Delicate Balancing Act Between Profit and Inventory. . . . . . . . . . . . . . . . . . . . Pg. 26
New President at QS/1 Announced . . . Pg. 7 Healthcare Legislation by The Book and Decoded . . . Pg. 8 Pharmacy Audits — What’s Behind the Increase and How to Survive One . . . Pg. 10 HME Audits — What’s Behind the Increase and How to Survive One . . . Pg. 12 Feature — QS/1 Customers Discuss 19.1.6 . . . Pg. 14
Enhanced Workflow . . . Pg. 14
Pharmacy At A Glance . . . Pg. 15
Will Call . . . Pg. 16
SystemOne® Notes . . . Pg. 17
Point-of-Sale . . . Pg. 18
Customized Reports: The Ability to Share . . . Pg. 18
Service Pack Development . . . Pg. 20
Prescription Monitoring Program Service . . . Pg. 20 Customer Spotlight: Fisher Pharmacy . . . Pg. 21 Beyond Prescription Immediacy — ePrescribing Plays an Expanding
and Competitive Role in the Evolving Healthcare Environment . . . Pg. 22
From The Support Center | Correction Suggestions . . . Pg. 25 MSM Takes Into Account the Delicate Balancing Act Between Profit and Inventory . . . Pg. 26 Five Myths About Healthcare Reform . . . Pg. 28 More Revenue. More Quickly. ZirMed and QS/1 Selects ABILITY . . . Pg.29 QS/1 Customer Conference . . . Pg. 30
Insight | April 2011 | 3
Hot Topics Update on Short-Cycle Dispensing
The Center for Medicare and Medicaid Services (CMS) published a pre-release version of the short-cycle dispensing rule on April 5th. Two major changes were announced: 1. The original 7-day supply was increased to a 14-day supply. 2. The new effective date was extended from 1/1/2012 to 1/1/2013. Look for more information as it is release on the QS/1 website, www.qs1.com and in the weekly Insider.
Millions to get new drug plans
Millions to Get New Drug Plans as Medicare Simplifies Program. The federal agency that oversees Medicare hopes to make shopping for the best prescription drug plan a bit easier this year by eliminating duplicative plans offered by the same company. This will reduce the total number of plans from the nearly 1,600 available nationally.
Warning Against Repackaging Anticoagulant Drug
The Food and Drug Administration advised pharmacists to dispense the anticoagulant medication Pradaxa (dabigatran etexilate mesylate) only in the original manufacturer bottles or blister packages because of concerns about product breakdown. The agency also stated that patients should not place Pradaxa capsules in pillboxes or pill organizers. The product has a 60 day expiration date.
4 || Insight Insight || April April 2011
New Safe Labeling Rules For Injectable Medications
U.S. Pharmacopeial Convention (USP) Issues New Safe Labeling Rules For Injectable Medications. Injectable medicine vial labels would contain only cautionary statements intended to prevent life-threatening situations under new requirements being advanced by the USP. “The new requirements... are intended to make it more likely that doctors, nurses, pharmacists and other healthcare practitioners using injectable products will be able to better see and act on labeling statements that convey important safety messages,” stated USP CEO Dr. Roger L. Williams.
The President’s Fiscal Year 2012 Budget released in February
The President’s Fiscal Year 2012 Budget, released in February, includes two provisions that are of significant concern to the HME market: a prepayment requirement on all power wheelchair claims and the limiting of Medicaid reimbursement of HME to Medicare rates set under competitive bidding. The American Association for Homecare is working on bipartisan legislation that would end the Medicare competitive bidding program for HME, arguing that the program sacrifices care for seniors and people with disabilities, is anti-competitive, creates job losses and is not a cost effective solution for healthcare. In an effort to combat fraud and abuse, Medicare employs third party audit contractors to monitor HME billing practices and reimbursements. Lobbyists contend new audit standards established by Medicare contractors are having the following unfair, unintended consequences: • Data regarding fraudulently paid claims is being distorted; • Eligible Medicare beneficiaries are not receiving medically necessary and covered benefits; • Auditors for the Centers for Medicare and Medicaid Services (CMS) misinterpret and therefore misapply Medicare rules and regulations sometimes on a retroactive basis, leading to inaccurate error rate data; • Legitimate providers furnishing medically necessary items and services are being hurt by unjustified monetary recoupments; and • CMS will not be able to achieve the Administration’s goal of reducing the error rate until it modifies its current audit policies.
Insight Insight || April April 2011 2011 || 55
Medicare Part B CEDI Connection Changes
medication therapy management (MTM) program that focuses on lifestyle medicine Reference: Journal of the American Pharmacists Association March-April 2011; 51(2):184-188 Summary by Phar-line Source: Journal of the American Pharmacists Association
Common Electronic Data Interchange (CEDI), the distribution/processing center for DME MAC Medicare claims, announced that on April 30, 2011, all free dial-up connections to its gateway will no longer be available. Effective May 1, 2011, hyper-terminal and dial-up modems will be replaced with a direct electronic claims transmission process for Medicare batch claims. QS/1 has entered a partnership with ABILITY, one of six select network service vendors, to provide a direct connection to Medicare for claims submission, eligibility checking and claims status inquiry. See QS/1 Has Selected ABILITY, on page 29, for more information.
Objective: To describe a patient-centered MTM program that focuses on lifestyle medicine. Setting: Community pharmacy in Omaha, NE, USA from August 2008 to September 2010. Practice description: Traditional MTM services are combined with lifestyle medicine interventions for employees of a self-insured organization who have dyslipidaemia, hypertension and/or diabetes. Program participants meet one-on-one with a pharmacist 12 times during the first year of the program to ensure proper drug therapy and modify lifestyle behaviors (physical activity, nutrition, weight control, sleep, stress, and alcohol and tobacco use) through individualized programming. Practice innovation: Several patient-centered activities have been developed for the program with an emphasis on modifying lifestyle behaviors in conjunction with medications to manage participantsâ€™ chronic condition. In addition, a new specialty position in healthcare is being developed (the ambulatist) that focuses on maintaining the ambulatory status of individuals with chronic medical conditions through appropriate drug therapy, lifestyle medicine and care coordination. Main outcome measures: Biometric data collection and participant survey data at baseline and after 12 months. Results: Pilot data for 15 participants showed improvements in all measurements, including blood cholesterol, low-density lipoprotein cholesterol, blood glucose, body weight, physical activity level, fruit and vegetable intake, risk for myocardial infarction, risk for any cardiovascular disease event, self-reported unhealthy days and qualitative survey data. Conclusions: Pharmacists are in an ideal position to implement lifestyle medicine strategies in combination with MTM services to enhance patientcentered healthcare in a community pharmacy setting.
6 || Insight Insight || April April2011 2011
Tammy Devine Named QS/1 President When Tammy Devine joined the J M Smith Corporation, she had no idea the journey she was beginning. The year was 1982 and Devine was eager to put her computer programming knowledge to work. Little did she know that one day she would take the reins of one of the corporation’s divisions. Nearly 30 years after accepting the applications programmer job, Devine is poised to become president of QS/1. Current QS/1 President and J M Smith Corporation CEO Bill Cobb announced the appointment of Devine to the top position on March 24, 2011. During her time with the company, she has seen it grow from a business venture that seemed to have a very limited market to a thriving company that is on the forefront of pharmacy management technology. Devine knew early on that QS/1 was ahead of its time in the marketplace. Devine came on board as a programmer and helped continue the development of QS/1’s pharmacy management system alongside Bill Cobb and Mr. Jim Smith Jr., creator of the QS/1 pharmacy system. She has seen it evolve from a basic prescription processing platform to a system that encompasses all aspects of the pharmacy business, which helps pharmacies do more to serve their customers. Cobb knows QS/1 will be in secure hands with Tammy Devine leading the way. “There is no one better prepared than Tammy to lead QS/1 into the future,” Cobb said. “She’s led virtually every segment of the company at one point during her career. She will do a great job.” A native of North Carolina, Devine moved to the Palmetto State where she earned her Master’s of Business Administration and Bachelor’s of Computer Science Degrees from the University of South Carolina. Her expertise is not only utilized by QS/1. Devine is a member of the Converse College Board
of Trustees and the SC State Board for Technical and Comprehensive Education. She is also making history within the J M Smith Corporation. She will be the first female president of one of the corporation’s divisions. She is eager to tackle her new responsibilities and take QS/1 to the next level of excellence. “I’m excited about the outlook for QS/1,” Devine said. “Healthcare is a key industry for our nation, and QS/1 is ready to grow and ready to take on new challenges.” Devine says she is excited about leading the company in the future. She said as technologies continue to expand, QS/1 will develop ways for its customers to tap into those resources and make their businesses more efficient. “It’s become increasingly clear to the leadership of the corporation that managing a six division, 1,000 employee company is vastly different than the familyrun business of 21 years ago,” Cobb added. Cobb, who currently serves dual roles as QS/1 President and CEO of the J M Smith Corporation, is stepping aside as head of QS/1 to concentrate his attention on the corporation. Cobb led QS/1 through tremendous growth while at the helm but says just as QS/1 has grown, so has J M Smith’s other divisions. Because of this growth, managing the corporation requires more of his attention. Devine will begin her new role on May 9, 2011. Insight Insight | | April April2011 2011 | | 77
Healthcare Legislation by The Book and Decoded The Affordable Care Act One Year Later: What is Being Done to Fight Heathcare Fraud and Abuse? by S. Leigh Davitian, JD, Dumbarton Group and Associates, PLLC
Many considered 2010 the “Year of Healthcare Reform” but others believe 2011 promises to be the year of “real” reform. March 21, 2011 marks the first anniversary of the signing of the historic healthcare reform legislation known as the Affordable Care Act (ACA), which continues to receive relentless attention by both supporters and critics. Does this attention culminate anything positive? Are people celebrating its passage or cursing its existence? These are not questions that can be easily answered, since everyone has differing opinions. However, one important question that should be asked is: has the ACA been successful in the early stages of its implementation or is it heading for disaster?
Let’s look at the facts regarding ACA provisions to minimize fraud, abuse & waste The ACA represents a significant opportunity to build on the Centers for Medicare and Medicaid Services’(CMS) existing efforts to combat fraud, waste and abuse in Medicare and Medicaid. The new authorities provided to CMS, under the ACA, offer more “front-end” protection to keep those who are intent on committing fraud out of the programs and new tools for deterring abusive practices, identifying and addressing fraudulent payment issues promptly, and ensuring the integrity of the Medicare and Medicaid programs. Many of these new tools and resources have already been implemented and have a proven record of success since implementation in mid-2010. 8 | Insight | April 2011
Recently, the Department of Health and Human Services (HHS) and the Department of Justice (DOJ) released a new report showing that the government’s healthcare fraud prevention and enforcement efforts which evolved from the ACA, recovered more than four billion in taxpayer dollars in Fiscal Year 2010. This money was immediately returned to the Medicare Health Insurance Trust Fund, helping with its continued solvency. In addition to the aforementioned enforcement efforts, 2010 was a record year for recoveries obtained in civil healthcare matters brought under the False Claims Act. More than $2.5 billion, the largest in the history of the DOJ, was recovered and again placed into the Medicare Trust Fund. These instances were in 2010. What about 2011? Are there any real efforts to identify and stop rogue healthcare providers from taking advantage of the healthcare system?
Again, let’s look at the facts On February 2, 2011, CMS published an extensive final rule in the Federal Register implementing fraud and abuse controls provided in the ACA. The new rule implements many important reforms.
Focus on Preventing Fraud Before It Happens The ACA creates rigorous screening processes for providers and suppliers enrolling in Medicare and Medicaid in an attempt to keep fraudulent providers out of these government programs, before they are accepted.
A New Enrollment Process for Medicaid Providers States will screen providers to determine if they have a history of defrauding the government. Providers that have been expelled from Medicare or another state’s Medicaid will be barred from Medicaid and other government programs.
Temporarily Stop Enrollment of New Providers and Suppliers Medicare and state agencies will be observing trends that may indicate healthcare fraud, using advanced predictive modeling software, such as that used to detect credit card fraud. The program can temporarily stop enrollment of a category of providers or of providers within a geographic area that has been identified as high risk, as long as it does not affect patient care.
Stop Payment on Suspect Claims The new rule will allow Medicare and Medicaid payments to be withheld from program providers or suppliers if there is a pending investigation or action regarding a credible allegation of fraud.
Expand Overpayment Recovery Efforts The ACA expands the Recovery Audit Contractors (RAC) program to Medicaid, Medicare Advantage (Part C) and Medicare Part D programs to allow RACs to help identify and recover over, and under payments to providers across Medicare and Medicaid for the first time. The ACA also requires providers, suppliers, Medicare Advantage plans, and Part D plans to report and return Medicare and Medicaid overpayments within 60 days of identification.
Share Data to Fight Fraud The new rule improves coordination across agencies working to stop fraud and abuse and requires certain claims data from Medicare and Medicaid be centralized, making it easier for CMS and law enforcement officials to identify criminals and prevent fraud on a system-wide basis.
Enhance Penalties to Deter Fraud and Abuse The ACA provides the Office of Inspector General with the authority to impose stronger civil and monetary penalties on those found to have committed fraud. The Secretary of Health and Human Services (HHS) is also provided new authority to prevent problematic providers from participating in Medicare or Medicaid. Under the new law: • Providers and suppliers who lie on their applications to enroll in Medicare or Medicaid may be excluded from the programs. • Providers who identify an overpayment from Medicare or Medicaid but do not return it within 60 days may be subject to new fines and penalties. • Providers who are terminated from a state’s Medicaid program will be terminated from Medicaid programs in other states. The ACA also allows for stronger oversight controls, such as payment caps and pre-payment review of claims for high-risk services, including a surety bond requirement to ensure the integrity of Durable Medical Equipment (DME) and home health providers/suppliers. Only time and vigilance will tell whether these new efforts will continue to minimize healthcare fraud, waste and abuse that undermine the integrity of our government healthcare programs and drive up healthcare costs? Reversing the problem will require a long-term, sustainable approach that includes the unwavering support of government entities and our private sector partners. A long-term approach must start somewhere and the passage of the ACA is a step towards safeguarding important government healthcare programs. S. Leigh Davitian is CEO of the Dumbarton Group and Associates, PLLC, a Washington, DC advocacy and policy firm
New Resources to Fight Fraud The new rule provides an additional $350 million to ramp up anti-fraud efforts. More law enforcement agents, auditors and healthcare attorneys can be hired to fight abusive practices in the healthcare industry. Insight | April 2011 | 9
and punish fraud, bigger and better programs have been implemented, such as the HIPAA 1996 Health Care Fraud and Abuse Control Program (HCFAC). More recently, a joint initiative between the Department of Justice and the Office of Inspector General entitled Healthcare Fraud Prevention and Enforcement Action Team (HEAT) was established to focus primarily on hotbed fraud areas.
Pharmacy Audits– What’s Behind the Increase and How to Survive One by Mark Jacobs, R.Ph., Director of PAAS National ®
Ten years ago, pharmacies had about a one in three chance of a pharmacy audit in any given year. Today, pharmacy audits are almost routine. Recently a pharmacist called me and exclaimed, “I never thought they would come way out here in rural Montana to my pharmacy.” When you combine the increase in on-site audits with the expansion of desk audits, you have a serious business – a cottage industry having a tremendous impact on retail pharmacies. So what’s behind this increase? Much of it is in the name of preventing fraud, which represents 3-10% of all healthcare payments. With an expected total of over $2.5 trillion in healthcare expenditures this year, that represents a lot of money. While the False Claims Act has been used since 1863 to deter
10 | Insight | April 2011
On February 17, 2011, the task force arrested 111 doctors, nurses and executives who allegedly cheated the government out of $225 million in false claims, using kickbacks, money laundering and identity theft. “Our message is clear,” said Assistant Attorney General Lanny A. Breur of the Department of Justice’s Criminal Division. “We are determined to put Medicare fraudsters out of business.” In January 2011, Health and Human Services (HHS) announced new rules under the Patient Protection and Affordable Care Act. These rules create a rigorous screening process for providers and suppliers enrolling in Medicare, Medicaid and Children’s Health Insurance Program (CHIP) to keep fraudulent providers out of the programs, establish a new provider screening process, temporarily stop enrollment of new providers, and suspend payments while an action or investigation is underway. The suspension of payments, has caused great concern for providers who feel it uses a “guilty before proven innocent” mentality and could cause serious cash flow problems for innocent providers. Fraud costs taxpayers money and must be wiped out. In my experience, though, it is not fraud that costs pharmacies thousands of dollars in payment recoveries. Instead, recoveries are often in the name of plan compliance requirements. These can be found in plan definitions such as Data Integrity, “Clean Claims” and Improper Payments. Many pharmacies don’t realize that the plan compliance requirements they’ve agreed to are not restricted to what they read in their contracts. In fact, the contract often has very little to say about plan requirements. That information is in the Provider Service Manual, and pharmacies are bound by their contracts to know and follow the rules in the manual. Pharmacies used to receive provider manuals
in the mail, so it was easy to browse through the pages. Now most of them are online. Some are easy to access, such as those by Prime Therapeutics and Member Health. Others require a pharmacy to obtain a member log-in and password, making it more difficult for pharmacists to understand what is expected of them. Since much of what is required applies to other plans, pharmacies can start by reviewing one manual, then review another each month. Data integrity statements such as this one from a Medicare Part D addendum to an Express Scripts, Inc. contract provide definitions: 2.3.b Accurate Claims and Other Data. Provider shall provide to ESI, or its designee, claims and other data relating to services
before the audit, he said, “Unfortunately it wasn’t very good. Like most pharmacists, we took a signed prescription as the green light to dispense and then bill the insurance. We learned the hard way that a prescription is not sufficient to bill Medicare Part B.” You cannot survive a pharmacy audit by luck. Furthermore, the responsibility should not just fall upon the owner. A good pharmacy takes a team approach to data integrity. Everyone plays a role in ensuring a prescription meets quality assurance standards. Pharmacies can start with the basic prescription elements to make sure the patient’s first and last name on the hardcopy match the name on the insurance card.
provided to members which is accurate, complete and truthful to the best of the provider’s knowledge, information and belief.
Or this Clean Claim definition from a Member Health contract: 1.4 Clean Claim shall mean (that) … which contains all of
First initial/last name, a nickname, or listing a person’s middle name are all audit flags that may result in payment recovery. Month-day-year information must be included on all prescription orders, and that information must be entered in the software’s “date written” field.
the information necessary for processing, including, but not limited to, Medicare Part D Member identification number, prescription Drug Product NDC number, drug quantity, days’ supply, physician DEA number, date of service, (etc).
Finally, the Federal Improper Payment Information Act of 2002 defines that improper payment: (A) means any payment that should not have been made or that was made in an incorrect amount (including overpayments and
The drug name, strength, and quantity should match what was dispensed. Any changes require prescriber approval. Directions need to be specific and mathematically useful, and the corresponding days’ supply must be entered correctly. Drugs like Warfarin, Prednisone and infertility medications may also require that the prescriber indicate a range or “up to” amount. Refills should match and not exceed what was authorized.
underpayments) under statutory, contractual, administrative, or other legally applicable requirements; and (B) includes any payment to an ineligible recipient, any payment for ineligible services, any duplicate payment, payments for services not received, and any payment that does not account for credit of applicable discounts.
Recently, an updated definition in The Improper Payments Elimination and Recovery Act of 2010 adds when “documentation is not available to support payment.”
How to Survive A Pharmacy Audit The pharmacies I help often share the mentality of the pharmacist profiled in the April 2010 QS/1 Insight magazine article, Lessons Learned from a Medicare Part B Audit. Of the pharmacist’s understanding of documentation requirements
Finally, make sure the prescriber name and ID number match. Nurse Practitioners, Physician Assistants and Medical Residents should all have their own NPIs. If the prescription is for a controlled substance, they must have their own DEA#, and according to federal regulation, that number must appear on the prescription when it arrives at the pharmacy from the prescriber’s office. If you follow these guidelines, you’re well on your way to surviving an audit. Don’t miss the QS/1 Customer Conference in Indianapolis this year, July 13-16, 2011. Mark Jacobs will be providing specific audit examples of how you can prevent your pharmacy from having to repay thousands of dollars for legitimately dispensed prescriptions. Call 888.236.2427 to register now.
Insight | April 2011 | 11
Providers should have a plan that outlines their process when an audit request is received. This plan should include: • Train individuals on what an audit request looks like and to recognize it as a priority document. • Identify an individual in the company who receives the request and is the lead on all audit projects. • Establish method for management notification. • Outline the process for information gathering and time frames. • Distinguish a person who is to review all information and has the authority to approve the data to be sent. • List how the materials need to be arranged so that the
Audits– What’s Behind the Increase and How to Survive One by Sarah Hanna,VP ECS Billing & Consulting, Inc.
Medicare audits are being performed across the nation at a record pace. Remember the saying, “An ounce of prevention is worth a pound of cure?” That saying should be the motto for providers of HME products throughout the land. In order to be able to respond to an audit request and continue business while in the midst of an audit, providers must have a plan in place when they are under the scrutiny of a Medicare audit. Providers only have 30 days to respond and gather all the information requested when they receive an information request from one of the Medicare audit contractors. The auditors will request chart notes regarding the patient’s medical condition that requires the beneficiary to have the prescribed HME product/supplies. These chart notes are in addition to the documentation which providers must have in their charts prior to billing claims to various DME MACs. Insight| April | April2011 2011 1212| |Insight
auditor receives the package of information in a systematic order. • Identify what products are under scrutiny and how to handle future billings of those products.
This plan should be reviewed with all applicable team members. All documents should be verified against the requirements within the DME MAC Supplier Manual and the applicable Local Coverage Determination (LCD) associated with the product which the audit is encompassing. Chart notes need to be scrutinized against the LCD to make sure that the information matches the coverage requirements. Documents should meet all signature and specific information requirements as outlined in the LCD and supplier manual. In addition, patient, caregiver and physician signatures need to be legible. If the signature is not legible, the document must have the person’s name legibly printed on it. Delivery tickets, dispensing orders, written orders prior to delivery, certificates of medical necessity, detailed written orders, assignment of benefits, applicable test results, call logs for resupply requests, call logs on rentals to ensure that the patient still requires the equipment, and possibly the manufacturer’s invoice are just some of the documents which may be requested to be sent with the chart notes information. Bottom line: the audits are here to stay and your company will be affected. It is best to take a proactive approach to how you will respond to the audit, so that when your team receives a request they don’t panic, rush around in chaos or just ignore it. “An ounce of prevention is worth a pound of cure.” I think Benjamin Franklin knew what he was talking about with that quote…don’t you?
Insight | April 2011 | 13
by Richard Edmund, Technician, Creative Services, QS/1
QS/1 Customers Discuss 19.1.6 EnhAnceD Workflow
Service Pack releases are not all created equally. While the enhancements that are deployed by QS/1 are designed to improve the efficiency of your system, you do not always see them at work. Often, those new features run in the background of your system and require no interaction on your part. Other times, Service Pack releases give you the visual gratification that lets you know the system is hard at work for you. Service Pack 19.1.6 was recently deployed to QS/1 sites and boasts features that fall into both categories. Some are seen and some are hard at work in the background of your system. While we are always proud of our work, we take extra pride in the features our developers and programmers have crafted with the goal of making sure your business meets governmental regulations and keeping your operation lean and efficient. In the end, it is all about giving you more time to do what you do best: provide excellent customer service. 14 | Insight | April 2011
PhArmAcy At A GlAnce ®
QS/1’s NRx and PrimeCare allow you to process and track a multitude of information. Hundreds, if not thousands, of functions can take place at any given time. From prescription processing to adjudicating claims, it can be a full-time job keeping up with everything the system is doing for you. You can gather a lot of the information, but you have to spend time clicking through the queues. Now, QS/1 gives you Pharmacy at a Glance. This dashboard application sits on the NRx and PrimeCare desktops and shows you statistical data of what is happening in any given area. Jessica Mills is in charge of Order Entry at Holladay Healthcare in Winston-Salem, North Carolina. Six weeks after launching Pharmacy at a Glance on her PrimeCare workstations, she says, “The flow of information ensures everyone in the pharmacy knows exactly what is going on and where staff attention may need to be focused.” “Not everyone needs to see all of the information,” Mills said. “We can customize each workstation so each person sees only the information that pertains to them.”
You can set Pharmacy at a Glance to update at intervals that work for you. Some operations may want it to update every few minutes. For businesses that have slower activity, every five or ten minutes might be enough time between updates. Mills also adds that a nice feature is the ability to click on any category and be directed to that specific queue. “The big benefit is you don’t have to go to the different places to see what is happening,” said Mills. “Click the queue, and it takes you directly there so you can look at what is backing up in the system.” When asked how satisfied she is with Pharmacy at a Glance, Mills said, “On a scale of one to 10, I give it a 10.”
That was one of the crucial keys when Pharmacy at a Glance was in development. Programmers realized the wealth of information could be overwhelming. As in Mills’ case, her Order Entry technicians did not necessarily need to see claims adjudication errors. Pharmacy at a Glance can be set up at each workstation to display only the information that is relevant at that station. On the other hand, managers and pharmacists can set Pharmacy at a Glance to see everything that is happening. Thresholds can be set for each category, determining the color that is displayed. For example, queues that are under the first threshold are shown in green. Once that queue passes the warning threshold, it turns yellow, and after that queue passes the critical stage threshold, it turns red. “We monitor Pharmacy at a Glance on the floor so pharmacists can see what is going on,” Mills added. “It gives them the big picture overview of what is happening, and the visual of the colors gets your attention.” Insight | April 2011 | 15
In NRx and PrimeCare, Service Pack 19.1.6 adds the new Will Call feature. For pharmacies with a high volume of customers, knowing where to store prescriptions can become time consuming. “It is awesome,” said Willis High, Manager of Delta of Moncks Corner when asked about Will Call. Will Call helps you automatically store prescriptions in bins that you can customize. The Pharmacy Management System tracks the capacity of the bins and lets you know which one has available space for a prescription or even a batch of prescriptions to ensure they are all stored in the same place. Delta operates several pharmacies located in South Carolina’s Low Country. It is not uncommon for one of the stores to process 1,000 prescriptions on a typical Monday morning. Will Call gives the staff the information they need to help customers without having to interrupt the pharmacist. “We have four registers and a ton of activity,” Willis said. “Our customers come to one of the registers and ask, ‘Is my prescription ready?’ and then ‘What is the price?’ We had four people going to the pharmacists and interrupting them. When you’re filling 800 to 1,000 prescriptions, that is a lot of interruptions.”
“When we were developing the Will Call functions, we wanted to make sure we were doing everything possible to help the pharmacists and staff get the most from their time,” said a QS/1 Programmer who helped spearhead the project. Will Call has streamlined the flow of information at Delta. Before, the pharmacy used another application to store and locate prescriptions. While that system worked, High says there was a lot of redundancy between the two systems. When he heard QS/1 was developing Will Call, he was quick to call and ask if his store could get the upgrade early and be considered a test site. “We used it the first day we downloaded it and were able to eliminate our other application and bring everything into QS/1. It has helped us save twice the time,” High added. Development programmers on the project say Will Call helps determine where to store prescriptions, but when a customer picks up the order, the person helping to check them out can see in exactly which bin it is located. You can even customize the settings to designate refrigerated units as storage locations. You can set the unit’s capacity, and the system tracks what is being added and what is being removed when customers pick up prescriptions. That allows it to auto-assign based on which unit has the available space to accommodate the order. High says information at your fingertips is a very valuable tool to help improve customer service. The patient does not have to wait, and the pharmacist is not interrupted every few minutes. “If another pharmacy calls me and asks for my recommendation, I tell them QS/1’s Will Call is the way to go,” High said.
16 | Insight | April 2011
SystemOne Notes QS/1’s SystemOne for HME customers will quickly notice significant enhancements to the notes features with Service Pack 19.1.6. The staff at Andrew Brown’s Home Health Care in Scranton, Pennsylvania say they are taking full advantage of the capabilities to help deliver information that allows them to better serve patients.
Inside the note, you have free-text formatting available with room for 100 lines at 80 characters across. The ability to word-wrap has also been added. This gives you plenty of room to add as much detail as you need for the note. There is no need to write in short hand hoping everyone can translate it into the full meaning. Brown sums it up best. “You can write a novel now, as opposed to just tweeting.”
“We work with several facilities where patients have frequent changes to their needs,” said Robert Brown, Vice President of Operations for the provider. “We can add notes that tie to every transaction to make sure the information isn’t missed.” There are two types of notes in SystemOne: General Notes and Miscellaneous Notes. General Notes look similar to notes in previous versions of SystemOne. It’s when you start looking at Miscellaneous Notes that you realize how helpful they can be to keep the flow of information moving. Obviously, some notes are more crucial than others. To make sure a note gets the most attention, you can set it as High Priority. This adds a red exclamation mark to the note and moves it to the top of the list, where it will be seen first.
Insight | April 2011 | 17
Point-of-SAle If you have QS/1’s integrated Pointof-Sale system with NRx, many of the enhancements in 19.1.6 are driven to strengthen how the two systems work together. The first example is the new Perform POS Check. This feature prevents prescriptions from being checked out in Point-of-Sale if they have not passed the Quality Assurance check in the NRx Workflow. If the cashier tries to check out a prescription that has not been through the Quality Assurance stage, a warning will be displayed letting the cashier know the prescription is not ready to be given to the customer. There is also a check-out indicator that has been added to the Transaction Record in NRx. It cross references with Point-of-Sale to see if a prescription is out for delivery or has been delivered. When a prescription is sent for delivery, the Status column on the Transaction Record in NRx will indicate an “out for delivery” flag. This is helpful since it lets staff know where a prescription is just in case someone comes to the store to pick it up. Another great feature gives you the ability to print historical reports. Marla Appleman of Peterson’s Pharmacy is Hillsboro, Wisconsin likes the ability to print previous statements. “We have found it very useful when it comes to dealing with past due accounts,” Appleman said. “Before, we had to do print screens of the charge accounts. Now, we can print any previous month’s statement and show it to the customer to answer their questions.” QS/1 has also expanded the MethCheck Web Service. You can now use your Signature Capture Pad for customers to sign the log. The signatures are uploaded through Pointof-Sale, along with any pseudoephedrine purchases to MethCheck. If you would like more information about this service, contact the QS/1 Health Services Group at 800.845.7558, extension 1471.
Customized Reports: The Ability to ShAre
QS/1’s systems give you a plethora of reports from which to choose. These reports are designed to give you specific details about what is happening and break them down so you can put them into perspective. Often, though, you need to develop a customized report to fit your specific needs. Over the years, many customers have called QS/1 to share details of these reports and are eager to tell us how they have helped them. Why keep these customized reports to yourself? QS/1 is giving you the ability to share these reports with all of our customers. Service Pack 19.1.6 touts the ability to export and import customized reports from a shared section of QS/1’s Customer Support Center website. In a society that is used to peer-to-peer sharing of information, this solution makes perfect sense. Now, customers who craft a specialty report can upload it to our Support Center. Once the report is uploaded, our team of developers gives it test runs to ensure it works properly. Then, we remove any data from the sharing customer’s system and make it available online. Robert Brown, Operations Vice President at Andrew Brown’s Home Health Care in Scranton says he sees where there is a need for this type of sharing. “With new mandates coming down each year, like with Medicare where you are only allowed to go back one year to bill, we have customized reports that go
18 | Insight | April 2011
back to the last date that we can bill,” Brown said. “Reports like this might be useful for other operations.” Any QS/1 customer who wants to browse the list of available reports can select the Import option from Reports and sign into the Customer Support Center. From there, refine your search to platform or by name and get a preview of the reports. If you find one that works for you, simply download it and add it to your customized reports list. If you want to learn more about this function, consult your Help file or take time to view the Webinar online for your specific platform. You might be surprised how quickly you can upload and download these shared reports.
Insight | April 2011 | 19
Service pAck Development
Service Pack enhancement ideas come from a variety of sources. First, our team of market analysts is always looking at federal and state mandates that are in the works. Those laws can have a huge impact on how we run our business. In fact, more states are starting to require pharmacies to frequently report the controlled substances that are being filled. QS/1’s Pharmacy Management Systems are making the move not only to gather the information in a report, but also to automatically send that data to the proper agency at the time interval that keeps you compliant with the law. Some of the enhancement ideas pushed into development come from you, our customers. You work with our systems every day in real-world settings and have ideas that help push our products forward. These feature upgrades not only help you realize a savings in your time, but often that idea works in other pharmacies and operations across the country. We take your feedback seriously and review all of the ideas that are submitted in great detail. Our annual Customer Conference is a great location for that exchange of ideas. Get a few professionals in the room and a conversation that did not start with the promise of generating a Service Pack enhancement turns into a brain-storming session. That exchange is not just limited to our customers. QS/1’s management and development teams are often seen huddled around the building discussing ways to take our products to the next level of service. We are not content making enhancements just so you stay compliant with governmental regulations. Our focus is to make sure you are accomplishing the goals that got you into this business: spending time with your customers and making a difference in their lives.
19.1.6 Update New Rx Filling option in Pharmacy Management Using the incorrect prescriber on a claim has become a focus of auditors. This new option requires the data entry person to key the doctor’s name for all new orders. 20 | Insight | April 2011
Prescription Monitoring Program Service QS/1 created the Prescription Monitoring Program Service via PowerLine as another way to take the burden away from pharmacists, technicians and pharmacy managers. Since QS/1 began this service, it has expanded to include Alabama, Arizona, California, Colorado, Kentucky, Louisiana, Minnesota, Mississippi, North Carolina, North Dakota, Ohio, South Carolina, and Vermont. More states will be added in the future.
How it works: QS/1 will take the required information from PowerLine and build a file using the state’s required parameters. This information is submitted to the state’s chosen vendor daily, weekly, bi-weekly or monthly, depending on requirements. Another feature of the Prescription Monitoring Program Service is the assignment of an iManager account to each participating pharmacy. This account will identify all rejected claims submitted over the past year. The pharmacist can review rejected claims for reporting errors. The pharmacy will be notified by email when its file has been sent and reminded to check their iManager account for any errors. In the event no file was sent for the reporting period due to zero activity, your email subject will read, “Your prescription monitoring program report shows zero activity.”
How to enroll: Setting up this service is quick and simple. The first step is to contact the Healthcare Services Group at 800.845.7558, ext. 1471 or at email@example.com to enroll. After you sign an authorization form, you will be assigned an iManager account to check reporting activity for the pharmacy. After enrollment, the pharmacy will be contacted by Customer Support to ensure all flags and fields are properly set up to ensure a minimal amount of errors. At this point, QS/1 will begin reporting to the appropriate vendor on the pharmacy’s behalf. **There is a nominal monthly fee for this service.
QS/1 and Fisher Pharmacy and Gifts: Standing on a Firm Foundation by Kerry Philbeck, Staff Writer, QS/1
Long-lasting business relationships are important in the pharmacy industry. Due to the current economic crunch and competition among vendors at an all-time high, these relationships are becoming less common. This is not the case with QS/1 and Fisher Pharmacy and Gifts in Columbia, Tennessee. A loyal QS/1 Customer since 1980, Stewart Fisher and his staff have seen their share of changes over the years, but have always enjoyed a strong partnership with QS/1. Fisher states, “Our systems have never gone ‘down,’ our conversions have always gone super smoothly and anytime we have an issue that needs attention, the level of support we receive is great. We have always had a firm relationship with QS/1 and have grown together through the years.” The store originally opened in 1980 as The Medicine Shoppe and was later acquired by present owner Stewart Fisher in 1996. Stewart and his wife, Cathy, renamed it Fisher Pharmacy and Gifts. Currently, the staff at Fisher Pharmacy and Gifts utilizes Point-of-Sale (POS) and NRx to serve a customer base of 50,000. With such a large volume of prescriptions to fill and pharmacy and gift shop customers to serve, they are considering adding Interactive Voice Response (IVR) and automation to their services. Fisher and his dedicated staff are always looking for ways to take their customer service relations to the next level. “We offer a wide range of services in order to keep our customers happy and coming back,” he explains. Among these are prescription delivery, compounding prescriptions and a low-price guarantee. He continues, “We value our customers’ business, as well as their health, and ensure quality care from start to finish. We offer quality medicines and fill prescriptions with expert, efficient service.”
After practicing pharmacy for 35 years, he has seen many changes in the industry. For Fisher, “reliance on computers to do our job is one of the major changes I have witnessed. Today, we could not possibly do everything we have to do from a legal and clinical standpoint without them. Everything is computerized, from patient records to third party information to all the clinical safeguards,” he explains. Along with the pharmacy end of the business, the gift shop has also evolved over the years. They showcase unique, boutique-style baby gifts and now offer a baby registry. In addition, engraving and monogramming on many of their gift items is also available. “We saw the addition of the gift shop as a way to set ourselves apart from our competition, to offer something different, that nobody else had. The whole idea was that customers would enjoy shopping for more than just their prescriptions,” Fisher states. Stewart says he is looking forward to a promising future as he continues his partnership with QS/1. He is always looking for new ways to improve his business and says his relationship with QS/1 has already proven successful. As new products and services emerge from QS/1, he is excited about the prospects for growth and new business. The Fisher Family: son Brandon, wife Cathy, Stewart and daughter Ashlee. Insight | April 2011 | 21
Beyond Prescription Immediacy
ePrescribing Plays an Expanding and Competitive Role in the Evolving Healthcare Environment by Lee Ann Stember, President, National Council for Prescription Drug Programs (NCPDP)
The pharmacy industry has surpassed healthcare in leveraging information technology to improve care quality, patient safety, claims processing and operational efficiency. With ePrescribing, all stakeholders can have a dramatic and profound impact on improving healthcare. Independent pharmacists who have not adopted ePrescribing cite the lack of interoperability between pharmacy practice management and electronic health record (EHR) systems, low physician demand and fewer financial and internal IT resources among the primary challenges. Adoption of ePrescribing is set to accelerate sharply starting this year as providers scramble to qualify for $19 billion in incentives that will be available to those who demonstrate meaningful use (MU) of certified EHRs between 2011 and 2015. Under Stage 1, Eligible Providers must transmit 40% of permissible prescriptions electronically. Hospitals must enter at least one medication order using computerized physician order entry (CPOE) for more than 30% of patients seen by the facility or admitted to its inpatient or emergency department. These thresholds should rise significantly under Stages 2 and 3. 22 | Insight | April 2011
Health reform mandates that covered entities implement rules to standardize administrative and financial transactions.
ePrescribing Under Stage 1, hospitals must comply with 14 core objectives along with five objectives from a “menu” of 10 objectives. Physicians must meet 15 core objectives and five menu objectives. Besides CPOE and ePrescribing, Stage 1 ePrescribing criteria require providers to: • Implement drug to drug and drug allergy interaction checks. • Maintain active medication lists. • Implement drug formulary checks. • Perform medication reconciliation. According to ePrescribing network SureScripts, the volume of ePrescribing in the U.S. more than tripled from 240 million in 2008 to 800 million in 2009. The percentage of independent pharmacies accepting electronic prescriptions increased from 44% to 60% over the same period. The number of office-based ePrescribers rose from 74,000 in 2008 to over 200,000 in 2010, about a third of office-based physicians. This was fueled partly by a 2% bonus Centers for Medicare and Medicaid Services (CMS) began offering in 2009 to
doctors prescribing electronically under Medicare Part D. The incentive, which was reduced to 1% of Medicare pay in 2011, will become a penalty of 1% in 2012, 1.5% in 2013, and 2% in 2014 and beyond for physicians not using ePrescribing. This, combined with MU funding, will motivate practices even more than before to replace paper prescriptions.
What ePrescribing means for pharmacies ePrescribing enables pharmacists to electronically receive, process, and dispense drugs, and also to address any related clinical and third-party issues more efficiently. Currently, pharmacies spend a lot of time processing handwritten or phoned-in prescriptions. Pharmacists have to enter these in their software and follow up with physician offices whenever there are problem causing delays. Pharmacies receiving orders electronically from physicians minimize calls and eliminate data entry and rework, streamlining workflow, improving efficiency, and increasing productivity and cost savings. According to a 2007 report by Michael T. Rupp, Ph.D., R.Ph., new ePrescriptions require 27% less pharmacy staff time and ePrescribed refills require 10% less staff time compared to other prescriptions and reduce pharmacy labor costs by 16% for new ePrescriptions and 6% for ePrescribed refills. Rupp estimates that ePrescribing can save pharmacies $1.07 and $.41 for every new ePrescription and e-refill, respectively.
A boost for medication therapy management services ePrescribing also lets independent pharmacies establish a new revenue stream by using their saved time to provide medication therapy management (MTM) services. Independent pharmacists know their patients, enabling them to provide highly personalized, high quality care. Often, patients are friends and neighbors who have built relationships with their pharmacists, who become trusted clinical advisors, placing pharmacists in a unique position to provide in-depth and comprehensive MTM services.
Unfortunately, few payors other than Medicare reimburse for MTM services. Many pharmacists already provide the services but are not documenting it. Others are waiting for commercial insurers to see the value and pay for MTM services before investing their time and resources. ePrescribing allows independent pharmacists to prove the value of MTM interventions to payors. Studies show that every dollar spent on MTM can save $12, but additional data is necessary to persuade commercial payors to follow CMS in reimbursing for medication adherence services. MTM provides a mechanism for pharmacies to build and strengthen customer loyalty. Consumers are more likely to go to pharmacists who help them save money and use medications safely and appropriately. Pharmacies that provide MTM now will be ahead of the pack when insurers start reimbursing for the services. Investing the resources to handle as few as 1-2 Part D cases per day may lead to a payoff of 7-8 patient cases per day, making MTM services a profitable revenue stream and a means by which to differentiate the pharmacy from larger competitors.
Filling the doughnut hole Bigger MTM patient panels may arrive soon. As part of health reform, pharmaceutical manufacturers began offering a 50% discount to seniors caught in the â€œdoughnut holeâ€? this year. This discount will boost Part D prescription volume by making medications more affordable to seniors who previously split pills or failed to obtain medications and refills once they reached the doughnut hole. This will lead to more requests from CMS for MTM interventions. In 2013, CMS will phase in subsidies for brand name and generic drugs. By 2020, manufacturer discounts and CMS subsidies will total 75% of the cost of brand names and generics. National Council for Prescription Drug Programs (NCPDP) has been developing standards to support MTM transactions Insight | April 2011 | 23
between health plans and pharmacies. In January the American National Standards Institute (ANSI) approved the MTM Service Request and Response transactions that NCPDP drafted last year as part of the NCPDP Specialized Implementation Guide. The standard enables insurers or other entities to request that pharmacies, providers, pharmacists, or other entities provide MTM services electronically. During the next quarter, NCPDP will ballot an enhancement to the Specialized Implementation Guide to add MTM transaction that will communicate MTM service documentation. NCPDP will also ballot enhancements to the SCRIPT Implementation Guide to add transactions for the exchange of query transactions between pharmacies and prescribers for new prescription information and the exchange of electronic health records as part of patient care between entities. NCPDP’s ballot process is the result of the industry working on a business need by bringing the recommendations forward for approval of the membership and any interested parties.
Hurdles As beneficial as ePrescribing is, pharmacists pay $.20 or more for every electronic prescription while those benefiting the most from ePrescribing, including health plans, employers and pharmacy benefit managers, don’t incur any transaction fees. Plus, unlike physicians, pharmacists receive no federal incentives or bonuses to adopt ePrescribing. As the physician adoption rate and volume of ePrescribing grows and transaction costs continue to fall, the business case for ePrescribing will become compelling for all pharmacies. Today, a pharmacy receiving most of its prescriptions electronically runs much more efficiently than the one that processes mostly paper prescriptions. The discrepancy in performance, however, is closing as more physicians adopt ePrescribing, putting pharmacies incapable of receiving prescriptions electronically at a competitive disadvantage. When patients don’t identify a preferred pharmacy, physicians will send prescriptions to pharmacies that have ePrescribing systems to avoid the hassles associated with written and faxed orders. 24 | Insight | April 2011
The technology backbone To ensure a successful investment in ePrescribing, pharmacies should select solutions that support the NCPDP SCRIPT, Formulary and Benefit, and Telecommunication standards. Physicians are now using NCPDP SCRIPT 8.1 standard to prescribe electronically. Last year, CMS approved an updated version – NCPDP SCRIPT 10.6 – as the new ePrescribing standard. 10.6 allows pharmacies, prescribers, PBMs and payors to: • Provide prescriber order numbers, National Drug Code source information, pharmacy prescription fill numbers and date of sale information. • Enhance interoperability. • Match, identify and eliminate records more efficiently. Another important NCPDP standard pharmacies should be aware of is the Telecommunication Standard version D.0, which healthcare organizations must adopt as part of the HIPAA transaction sets that become effective January 1, 2012. Participants in the industry are already exchanging D.0 claims. The D.0 standard includes improvements: • Coordination of benefits and Medicare Part D claims processing requirements. • Access to pharmacy eligibility information. • Identification of patient’s financial responsibility, benefit stages and coverage gaps on secondary claims. • Billing of multiple ingredients for claims processing for compounded drugs. • Reporting of controlled substances in cough, cold and other over-the-counter medicines. Stimulus funding and federal support of interoperability and health information exchange standards are encouraging providers to deploy health information technology (HIT) to transform quality, safety and cost effectiveness of care across the health system. Pharmacies that embrace automation when others hold off will lead the way toward a new generation of connected care.
From The Support Center | Correction Suggestions Correction Suggestions, available from the ECS Claim Rejection Detail window, was created to help customers with rejected claims in NRx. Customers can select a rejected claim in the Electronic Claims Log. The rejection code, with its verbiage, displays on the right side. Click the code to receive suggestions on how to get the rejection corrected. For example, if you receive an error message in NRx of DQ M/I Usual _Customary, the following suggestions display:
If you receive multiple rejections on a claim, click the first rejection to see what action is needed. Then click Next to see the next rejection, along with suggestions for correcting that rejection. Correction Suggestions is useful in getting rejected claims paid. If you need assistance or have questions, please call Customer Support to assist you at 800.845.7558, ext.1408.
Insight | April 2011 | 25
MSM Takes Into Account the Delicate Balancing Act Between Profit and Inventory
by L. Preston Hale, R.Ph., Strategic Account Manager, QS/1
The Bottom Line: “With QS/1’s new MSM Inventory On Hand Tracking Log, they have created an industry game changer,” says Peter Hess, accountant, CFO and an owner of Hometown Pharmacies in Pennsylvania. Accounting is easy; for every debit, there is an equal and opposite credit. A third-party sale displays on the Income Statement as a sale and on the Balance Sheet as an increase in Accounts Receivable. Simultaneously, the cost of the product sold is expensed on the Income Statement, and Inventory is reduced on the Balance Sheet. That seems simple enough and every pharmacy software system has reports that detail sales, gross margin and inventory numbers. The challenge is to get those sales and cost numbers to balance for beginning and ending monthly Accounts Receivable and Inventory reports. In years past, pharmacies could balance once a year and assume that large swings in numbers would come back the next year. However, in these turbulent economic times,
26 | Insight | April 2011
not having accurate financial numbers could spell disaster for your company. Pharmacies today need numbers they can count on to allow for quick responses when making financial decisions and to make sure they are on top of their cash flow. From an accountant’s perspective, the Balance Sheet provides the checks and balances necessary to ensure all of the numbers are correct. The Balance Sheet shows how much money you have in the bank on a specific date, how much you are owed in accounts receivable, the value of your inventory and your liabilities. Third Party Accounts Receivable has a Beginning Balance. Sales are added, Payments and Adjustments are deducted, leaving an Ending Balance. Likewise, Inventory adds the Purchases received in the month and deducts the product sold, leaving an Ending Inventory Balance. If you start making estimates with these numbers, the results can lead to reports that are widely inaccurate, resulting in over or understated profits.
The challenge has always been to provide the Accounting System with reliable financial data from the pharmacy software system. Is the Third Party Accounts Receivable Sales number the true adjudicated amount that pharmacies expect to collect from the insurance company? Do rejected claims, fees, or paper claims distort the sales numbers? Does the Received on Account payments match the amounts deposited into the bank? Was there a clean cutoff at the end of the month between the two systems (ROA and Deposits)? Are you electronically reconciling claims, where there are 835 files that were partially paid in two months? Then, after all of that, the controlling number is adding up all of the unreconciled claims in the Pharmacy System and adjusting the Ending Balance in the Accounting System to match and report sales. Again, the total of un-reconciled claims is what businesses expect to collect. The good news is that in using MSM’s Daily Sales Journal, you can view credits and reversed transactions, and it gives a far more accurate number. It can list every transaction and lets you research anomalies. MSM also has a Received On Account Reconciliation report that can be used to balance the cash account deposits. Net Rx and the 835 files can run on both the NRx and MSM system, which provide another form of checks and balances to get an accurate Accounts Receivable (or un-reconciled claims). The other part of the equation is inventory and inventory tracking. From an accountant’s standpoint, the tangible asset or balancing number is the Inventory Value at a certain point in time. The cost of goods sold and gross margin numbers from Sales reports can vary depending on the report and when it was run and can often lead to the wrong numbers being posted. Although the Inventory reports run out of QS/1 are accurate, it is unclear whether every location is following the same procedure. Consistency is important to get a clear picture of what is going on financially. Make sure acquisition costs are routinely updated, all purchases are entered into inventory, returns to suppliers are recorded, and expired products are taken off the shelf and removed from inventory to get detailed accounting numbers.
If the steps are not being taken in your operation, you will find that with QS/1’s new MSM Inventory On Hand Tracking Log you can access real-time reports to show purchases, the cost of goods for each script, and every manual adjustment made in the system. This report can be a game changer for the pharmacy industry. By downloading to Excel, you can track a prescription as it is created, updated and/or voided and get a true “Cost of Goods.” You can track a specific drug by purchases, corrections and dispenses in a month. You can compare invoices by line item to spot check cost, quantity and monthly cutoffs. From an accounting point of view you can track manual adjustments being made to inventory and when they were made for outdates, returns, shortages, inter store transfers and more. Balancing and accurate reporting means having accurate and supportable numbers for both Inventory and Third Party Accounts Receivable data. Almost everyone has been estimating because software companies have never been able to provide accurate numbers until now. In the last few years, pharmacies have started to get a handle on the third party A/R side by reconciling claims, but inventory numbers have always been a mystery. The truly extra-ordinary thing that QS/1 has created via the Inventory Tracking Report is the missing piece of the puzzle. Being able to track Rx’s when created, updated and voided is remarkable. Being able to see if costs are up to date or if things are returned for credit or pulled because they are not picked up is huge and a necessity for proper reporting. “This is revolutionary,” Hess says. “The weakness of our industry has been the inability to have accurate Sales with Cost of Goods, A/R and accurate Inventory value. Now with QS/1, that is possible.” For more information about MSM and how it can streamline your operation call QS/1 at 800.231.7776.
Insight | April 2011 | 27
Five Myths About Healthcare Reform by Jeff Beadle, SIGIS
Myth 1 - Now that OTC drugs and medicines are no longer included in the Eligible Products List (EPL) list, SIGIS membership is not required or beneficial for FSA processing with a FSA/HRA debit card. • IRS regulations still require a merchant to have an IIAS system or file for a 90% Rule exemption. While it is true that almost 16,000 items were removed from the EPL because they now require a Rx for reimbursement with an FSA or HRA debit card, the SIGIS standard still supports these areas: – Prescription only products, regardless of payment method, – OTC Drugs and Medicines when a prescription is present, and – Over 23,000 OTC supplies and devices that remain eligible without a prescription. • SIGIS offers an industry-wide solution for the processing of health benefit debit cards. Myth 2 - The Eligible Products List (EPL) is no longer a beneficial resource as OTC drugs and medicines have been removed. • The EPL still provides over 23,000 OTC supplies and devices that remain eligible without a Rx. These include items such as bandages, first aid supplies, reading glasses, hearing aids, contact lenses, braces and supports, canes, walkers, diabetic supplies and many more. The EPL is a required component for SIGIS IIAS certified merchants and is helpful for SIGIS 90% Rule merchants when determining qualifying products towards the 90% threshold. Myth 3 - Merchants who qualify for the 90% Rule no longer need to be SIGIS members. • IRS regulations still require merchant locations to support an IIAS system or file for a 90% Rule 28 | Insight | April 2011
exemption for the usage of FSA and HRA debit card for payment. SIGIS offers merchants a solution for the 90% Rule exemption that is recognized by a majority of Plan Administrators.
Myth 4 - Some Plan Administrators have stated that participants are no longer allowed to use their flex cards for OTC Drugs and Medicines that require a prescription and to submit another form of payment and then submit receipt for reimbursement. • IRS notice 2010-59 issued September 3, 2010 had limited “OTC Drugs and Medicines” that have a prescription to manual claim process between the plan participant and the plan sponsor. Subsequent IRS Notice 2011-05 issued on December 23, 2010 additionally allowed the use of a FSA or HRS debit card for “OTC Drugs and Medicines” when a prescription is present and the drug is dispensed in accordance with state law. Due to the fast-moving nature of this item in the December and January time frame, many Plan Administrators may have issued initial guidance and then updated their plan participants later. Plan participants should check the most recent communication from their plan sponsors to find out the options available to them. Myth 5 - Some Third Party Administrators (TPAs) will no longer support 90% as a result of healthcare reform. • Support of the SIGIS 90% program is a TPA / Plan Sponsor individual decision. SIGIS has not seen a significant shift in the TPA / Plan Sponsors that choose to support our standard as a result of healthcare reform.
More Revenue. More Quickly.
QS/1 has selected
In an effort to provide SystemOne customers with the most cost-effective, advanced claims management and accounts receivable tools, QS/1 has partnered with ZirMed. These tools include: electronic claims submission, electronic payment posting, real-time eligibility checking, claims status inquiry and patient statement services with e-pay.
QS/1 has selected ABILITY (formerly VisionShare) as an Internet-based replacement for the dial-up method of DME claims submission to the National Government Service CEDI Gateway. ABILITY connects tens of thousands of physicians and DME Suppliers across the country with the nation’s largest payor, Medicare, and with thousands of hospitals, skilled nursing facilities, home health agencies and clinics.
SystemOne customers can now utilize ZirMed to verify patient eligibility, submit claims, receive electronic remittance advice, and process patient payments from within their QS/1 systems. QS/1 and ZirMed have even developed the technology to allow a pharmacy or HME provider to send, receive, and post files automatically into SystemOne. By utilizing this powerful suite of business management tools, SystemOne customers report savings between 30% 50% in monthly clearinghouse charges. With ZirMed, A/R days outstanding is reduced and a higher percentage of patient responsibilities are successfully collected. These savings, combined with interactive training and premier customer support, make transitioning to ZirMed a simple decision. In addition, as industry regulatory changes occur, know that ZirMed, like QS/1, is ahead of the curve in preparing for the changes and educating our clients on how to prepare. More specifically, for 5010 and ICD-10 changes, please visit ZirMed’s 5010 resource center at http://info.zirmed. com/5010resourcecenter. This page features many links to helpful resources, including readiness checklists and documents you can utilize to evaluate preparedness of your organization for the pending changes. Learn more about how these integrated solutions can help your business get more revenue, more quickly. To see how ZirMed’s complete revenue cycle management solution integrates with SystemOne, contact QS/1 Marketing at 800.231.7776. If you have specific questions or would like to see a product demonstration, contact ZirMed partnership representative Rich Baldwin by email at Rich.Baldwin@ zirmed.com, by phone at 877.494.7633, ext. 5431, or visit http://info.zirmed.com/QS1Demo.
QS/1 customers can take advantage of the ABILITY Secure Exchange Site, an easy-to-use web portal, for sending and receiving CEDI claim files. The ABILITY web portal also includes access to real-time Medicare eligibility and same-and-similar claim status. This complete package of services provides capabilities that will help QS/1 customers improve efficiency, simplify claim work flow, and reduce denials. QS/1 chose ABILITY for the following reasons: • Ease of installation & use: ABILITY Secure Exchange Site takes minutes to install & requires minimal training. • Cost predictability: ABILITY services are offered at a low flat rate price for unlimited usage. DME billers can use as much or as little as they need without worrying about cost. • Productivity: Users can leave the ABILITY system up all day, avoiding the need to sign in and out multiple times per day. • Speed & efficiency: ABILITY users have quick online access to information previously accessed using the slow IVR, such as eligibility verification and sameand-similar status.
The healthcare landscape is changing, and ABILITY stands ready to support and raise the delivery of care efficiently to every corner of the country. Healthcare providers will be able to take advantage of upcoming integration for important clinical network services, using tools and services from ABILITY. ABILITY is elevating the healthcare conversation.Visit the ABILITY website at www.abilitynetwork.com., for more information. Insight | April 2011 | 29
Wednesday, July 13 (optional, additional fee)
SystemOne Workshop – 3 Tricks of the Trade for HME: Getting the Most out of SystemOne 1:00 – 5:30 – Essential Reporting Tools | Claims Management | SystemOne Top 10 Commonly Asked Questions
Retail Pharmacy Track – NRx & RxCare Plus
HME Track – SystemOne
Thursday, July 14
Thursday, July 14
7:30 – 8:30 8:30 – 9:00 9:00 – 10:00 10:00 – 10:30 10:30 – 12:00 12:00 – 1:00 1:00 – 5:00 1:00 – 2:00 2:00 – 3:00 3:00 – 3:30 6:00 – 9:00
Continental Breakfast Conference Welcome & Introductions Opening Speaker - Earthquake Relief Efforts - Bill Drake, Pharm D, Advanced Care Pharmacy Services Break Data Extraction Requirements for Pharmacy Audits (1.5 CE) - Mark Jacobs, R.Ph., PAAS National Lunch Expo Open Understanding SIGIS - Jeff Beadle, SIGIS (1.0 CE) IVR/Web Refills/POS Break in Expo Indianapolis Motor Speedway Private Dinner & Museum Tour
Friday, July 15 7:30 – 8:30 8:30 – 10:00 10:00 – 10:30 10:30 – 12:00 12:00 – 1:00 1:00 – 5:00 1:00 – 2:30 2:30 – 3:00 3:00 – 3:30
Continental Breakfast Regulatory Update - Brad Kile, Dumbarton Group, LLC (1.5 CE) Break NRx Enhancements Lunch Expo Open Electronic Health Records - Shelly Spiro, Pharmacy e-HIT Collaborative (1.5 CE) New Technology in Healthcare Break in Expo
Saturday, July 16
7:30 – 8:30 Continental Breakfast 8:30 – 12:00 Expo Open 8:30 – 9:00 QS/1 Healthcare Services 9:00 – 10:00 Multi-Site Management (MSM) Update 10:00 – 10:30 Break in Expo & Door Prize Drawing 10:30 – 12:00 RxCare Plus Enhancements 12:00 – 1:00 Lunch 1:00 – 2:00 QS/1 Best Practices Round Table: Tips & Tricks (All Products) 2:00 PM Conference Adjourned 30 | Insight | April 2011
7:30 – 8:30 8:30 – 9:00 9:00 – 10:00 10:00 – 10:30 10:30 – 12:00 12:00 – 1:00 1:00 – 5:00 1:00 – 3:00 3:00 – 3:30 6:00 – 9:00
Continental Breakfast Conference Welcome & Introductions Opening Speaker - Earthquake Relief Efforts - Bill Drake, Pharm D, Advanced Care Pharmacy Services Break HME Industry Update – Sarah Hanna, ECS Billing & Consulting Lunch Expo Open Building Partnerships that Increase Revenue Break in Expo Indianapolis Motor Speedway
Private Dinner & Museum Tour
Friday, July 15 7:30 – 8:30 8:30 – 10:00 10:00 – 10:30 10:30 – 12:00 12:00 – 1:00 1:00 – 5:00 1:00 – 2:00 2:30 – 3:00
Continental Breakfast SystemOne Enhanced Features & Functionality Break Medicare Audits: Risks & Being Prepared Lunch Expo Open Improving Inventory Control SystemOne Interactive Voice Reponse (IVR)
3:00 – 3:30
Break in Expo
Saturday, July 16 7:30 – 8:30 8:30 – 12:00 8:30 – 10:00 10:00 – 10:30 10:30 – 12:00 12:00 – 1:00 1:00 – 2:00
Continental Breakfast Expo Open Retail Management Technology: Keys to Ensuring Profitability Break in Expo & Door Prize Drawing SystemOne Hidden Secrets & Proven Solutions Lunch QS/1 Best Practices Round Table: Tips & Tricks (All Products)
On Your Mark . . . Get Set. . . LTC Track – PrimeCare Thursday, July 14
7:30 – 8:30 8:30 – 9:00 9:00 – 10:00 10:00 – 10:30 10:30 – 12:00 12:00 – 1:00 1:00 – 5:00 1:00 – 2:00 2:00 – 3:00 3:00 – 3:30 6:00 – 9:00
Continental Breakfast Conference Welcome & Introductions Opening Speaker - Earthquake Relief Efforts - Bill Drake, Pharm D, Advanced Care Pharmacy Services Break Data Extraction Requirements for Pharmacy Audits (1.5 CE) - Mark Jacobs, R.Ph., PAAS National Lunch Expo Open Report and Data Export Logic Billing Procedures Break in Expo Indianapolis Motor Speedway Private Dinner & Museum Tour
Friday, July 15 7:30 – 8:30 8:30 – 10:00 10:00 – 10:30 10:30 – 12:00 12:00 – 1:00 1:00 – 5:00 1:00 – 2:30 2:30 – 3:00 3:00 – 3:30
Continental Breakfast Regulatory Update - Brad Kile, Dumbarton Group, LLC (1.5 CE) Break PrimeCare and WebConnect Enhancements Review Lunch Expo Open Electronic Health Records - Shelly Spiro, Pharmacy e-HIT Collaborative (1.5 CE) New Technology in Healthcare Break in Expo
Saturday, July 16 7:30 – 8:30 8:30 – 12:00 8:30 – 10:00 10:00 – 10:30 10:30 – 12:00 12:00 – 1:00 1:00 – 2:00
Continental Breakfast Expo Open Workflow Review Break in Expo & Door Prize Drawing Short Cycle Dispensing Lunch QS/1 Best Practices Round Table: Tips & Tricks (All Products)
Make Plans to Join QS/1 in Indianapolis For The
2011 Customer Conference
July 13 - 16, 2011 JW Marriott Indianapolis Conference rate $139/Night To reserve a room call 888.236.2427 and request the special qs/1 rate
Register Now at www.qs1.com
Insight | April 2011 | 31
PRSRT STD US POSTAGE PAID CHARLOTTE, NC PERMIT 3307
PO BOX 6052 Spartanburg, SC 29304 Change Service Requested
©2011, J M Smith Corporation. QS/1 and FamilyCare are registered trademarks of the J M Smith Corporation. This publication is printed on recyclable paper and with environmentally friendly ink.
QS/1 ’s NRx has built-in InstantFill™ to automatically process ®
clean, valid refills. While pharmacists gain time to provide patientcentered services, InstantFill adjudicates refills and sends them to the dispensing queue. QS/1’s end-to-end technology and services work together to improve efficiency in your pharmacies. Every day.
1.800.231.7776 www.qs1.com © 2011, J M SMITH CORPORATION. QS/1 and NRx are registered trademarks and InstantFill is a trademark of the J M Smith Corporation.