Beginning in this edition, The Edge is sporting a new design. That does not change our mission to bring you content every two weeks that is relevant to community pharmacy. Industry news, regulatory matters, and QS/1 news is a quick read right here every other Wednesday morning.
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COVID-19 Audit Considerations
Due to COVID-19, many pharmacies have been asking about a reduction, and outright waiver, of PBM requirements. Most notably on the list of concerns are
Proof of delivery
Mailing/delivery restrictions
PBM overrides
Ongoing audits
State of Emergency/Executive Orders
PAAS® (Pharmacy Audit Assistance Service) National has issued information that is good material for any pharmacy to consider during this time.
We’re excited to introduce new message types for the pharmacy side of the ePrescribing network: RxChange and RxFill.
We worked hard to ensure the new version of the ePrescribing standard was ready for you prior to the CMS-mandated date, January 1, 2020. We took all the existing ePrescribing transaction types (NewRx, RefillRequest, CancelRx) and made the changes necessary to support the new 2017071 version. The number one priority of the New SCRIPT Standard was to reduce errors and increase patient safety, but the enhancements also boost the operational efficiencies of pharmacies and collaboration with prescribers. And the best news is this new functionality has been added at no additional charge.
As of April 16, 2020, the Advance Payment Program was suspended. The Advanced Payment Program was a loan requiring suppliers return the money from future claim payments. This program was suspended/paused due to the implementation of the CURES Act, which is making payments (not loans) to suppliers. Checks will be deposited from Optum Bank with a description of HHS Payment.
In addition, the 2% sequestration amounts previously withheld from DMEMAC Medicare payments will be suspended from May 1, 2020 - December 31, 2020. All audits have been suspended at this time but will eventually resume.
There are questions the DMEMACs do not have the answers to currently. They are waiting on CMS for further guidance. Please visit your DMEMAC website or CMS.gov for the most up to date information.
NPI Prescriber ID Processing
Due to COVID-19, CMS will continue to exercise its discretion to allow pharmacists to authorize emergency fills when prescribers are not available to provide refill renewal prescriptions, when consistent with State emergency declarations.
If a prescriber is unavailable to refill a patient's prescription, a pharmacist may authorize the refill. This emergency exception can only be used when the prescription from a pharmacist would be a valid prescription previously authorized by a prescriber.
Pharmacy claims should be submitted using a Type 1 NPI-Individual. However, if the pharmacist does not have a Type 1 NPI, CMS is allowing pharmacists to submit the pharmacy’s Type 2 NPI-Organization on the claim.
When submitting a Type 2 NPI, pharmacies will need to submit the following:
Field #
NCPDP Field Name
Value
42Ø-DK
SUBMISSION CLARIFICATION CODE
42
Current Releases
Make sure to download the latest service pack to obtain the most recent program changes. The most current service packs are: