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In office script dispensing-HELP

  1. #1
    Question In office script dispensing-HELP
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    I need some help.
    My office is starting to dispense scripts in the office.
    How do I bill for the scripts on the claims? Where do I find the codes?
    They have really dropped this in my lap, like they started yesterday and just told me.

    Shay

  2. #2
    Location
    Greeley, Colorado
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    Are you saying that your office is trying to charge for a patient to pick up a prescription? You can't do that - it is not a billable service.
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Location
    North Carolina
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    Or are you talking about EPrescribing?

    2010 eRx Incentive Program

    To participate in the 2010 eRx Incentive program, individual EPs may choose to report on their adoption and use of a qualified eRx system by submitting information on one eRx measure: (1) to CMS on their Medicare part B claims, (2) to a qualified registry, or (3) to CMS via a qualified electronic health record (EHR) product. Additional information on the registry-based or EHR-based reporting mechanism for the eRx Incentive Program is available by clicking on the "Alternative Reporting Mechanisms" link at left.

    http://www.cms.gov/ERxIncentive/

  4. #4
    Default
    Quote Originally Posted by Lisa Curtis View Post
    Are you saying that your office is trying to charge for a patient to pick up a prescription? You can't do that - it is not a billable service.

    We are offering to fill the patients scrips at our clinics for a seperate fee, as if they had gone to the pharmacy but without going through their insurance. It's just a flat script fee in our office.

  5. Default
    There are no billable codes that you can use to submit prescription claims for an indemnity plan at least on the 1500 form unless you can use NDC codes. Do a search for NDC codes.

    Pharmacists have been using electronic claims filing for years, but when prescriptions are covered under an indemnity plan and not under an actual prescription card plan, you can file a claim, but it will have to be on paper because you will have to describe the drug, dosage and etc at least that's how it used to work. In the past, you couldn't submit electronically - now, I'm not sure how the NDC codes would work or whether you can use a 1500 form and submit electronically.

    Hope this information helps you. Unfortunately, you're going to have to do a lot of homework on this to find out those you can file for and those you must just collect the fee from. I would love for you to keep us posted on how this plays out because there are a lot of companies out there trying to set doctor's offices up to dispense prescriptions and many of them aren't providing the information doctors need to actually get paid. I think this is going to be a big issue - maybe there will become a better way to getting paid and giving patients the convenience of filling scripts in their doctor's offices.
    Last edited by cyndeew; 08-04-2010 at 01:34 PM.
    Cyndee Weston, CPC, CMC, CMRS
    American Medical Billing Association
    www.ambanet.net/AMBA.htm
    AMBACode Coding Software
    http://www.ambacode.net
    2015 AMBA National Medical Billing Conference
    http://www.ambanet.net/2015.htm

  6. #6
    Location
    Greeley, Colorado
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    Quote Originally Posted by Showell14 View Post
    We are offering to fill the patients scrips at our clinics for a seperate fee, as if they had gone to the pharmacy but without going through their insurance. It's just a flat script fee in our office.
    How is your clinic obtaining the medications?
    Lisa Bledsoe, CPC, CPMA

  7. #7
    Location
    Columbia, MO
    Posts
    12,571
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    You will need a pharmaceutical dispensing license to dispense meds to the patient.

    Debra A. Mitchell, MSPH, CPC-H

  8. Default
    So I was interested in learning more and found some information. This FAQ at http://www.filterguide.com/mederx_questions.htm
    says:

    Can a Doctor officially dispense prescription medications from their own office? Yes, in most states every medical doctor has the right to dispense medication to his or her own patients by law when the administration is limited to the physicians own patients and the medications meet FDA procedures for re-packaging and labeling. Only four states control dispensing to any large level (New York, Montana, Texas and Massachusetts). In these states, medication dispensing is allowed but is controlled.

    and this one was interesting:

    What if my patients have medical drug insurance benefits?
    Given rising co-pays, prior authorization requirements and seniors' confusion over the Medicare drug benefit, dispensing is a great service even for patients with a benefit. In many cases, your office can provide generics at a price equivalent to the patient's co-pay, making it an easy decision to get medications from your office and save a trip to the pharmacy.

    So I'm guessing that some programs would not allow you to bill insurance. You would only collect fees from patients.

    But, this company http://www.drdispense.com/ says: Our program offers pre-packaged medications, Electronic Billing, E-Prescribing, HL7 Compliant EHR Integration, Inventory Management, regulatory reporting, and much more. Also see http://www.drdispense.com/programs.php

    So this one sounds like you actually could bill insurance.

    Do you know if the company your practice will use has these abilities?

    Also, there is a wealth of information on NDC codes at this website. http://www.fda.gov/Drugs/Development...cess/UCM070829 According to Wikipedia, The National Drug Code (NDC) is a unique product identifier used in the United States for drugs intended for human use. And this MASS state website has some good info on using NDC codes http://www.mass.gov/?pageID=eohhs2te...s&csid=Eeohhs2 From what I've read, these codes are not used for billing physician dispensed medications.

    Thank you for bringing up this subject. Our office has been approached multiple times regarding this type of service and we've been leery of it. It might be worth investing more time on.
    Cyndee Weston, CPC, CMC, CMRS
    American Medical Billing Association
    www.ambanet.net/AMBA.htm
    AMBACode Coding Software
    http://www.ambacode.net
    2015 AMBA National Medical Billing Conference
    http://www.ambanet.net/2015.htm

  9. #9
    Default
    Thank you so much for this information.

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