Message from Mike
Medicare Part D
reimbursements too slow?
|
Problems pharmacists are having with
slow pay/no pay is being addressed at the federal
level, in addition to our previously reported help
from the Texas Department of Insurance. The
National Community Pharmacists Association is
gathering information on provisions of a federal
prompt pay law that recently went into effect.
As of Jan. 1, 2010, Medicare Part D
sponsors MUST pay retail pharmacies within 14 days
for clean claims or 30 days for claims not
submitted electronically. The change, a key
legislative initiative of NCPA's, stems from
provisions of the Medicare Improvement for
Patients and Providers Act of 2008.
A
"clean claim" is defined as a claim that has no
defect or impropriety that prevents timely payment
from being made. A claim is deemed clean if the
plan does not provide the pharmacy notice of any
deficiency within 10 days for an electronic claim
and within 15 days for claims transmitted
otherwise. This requirement does NOT apply to mail
order and long-term care pharmacies.
In
addition, it's important to recognize that a PDP
sponsor must pay all clean claims submitted
electronically by Electronic Transfer of Funds if
the pharmacy requests such payment methodology.
When payment is made electronically, remittance
may be made by the PDP sponsor electronically as
well. If you are not receiving payment via EFT
today and would like to, please request so from
the payer.
Are you having trouble with
delayed payments? NCPA needs your help to document
real stories to bring before legislators and
regulators.
Please click here to fill out a brief
survey regarding your experiences with prompt
pay.
Heads up: Use
physician's NPI number on Part D
claims
The Centers for Medicare
& Medicaid Services reports a significant
number of pharmacies are not placing the
physician's National Provider Identifier number on
their Part D claim. CMS says it has been giving
flexibility to plans to not enforce this
provision, which is required under HIPAA, but may
have to start including hard edits in Part D
prescriptions that don't include them. It seems
clear that pharmacists must use NPIs. If you
don't, CMS may consider the omission an auditable
item or you could lose their ability to bill Part
D.
Continued
success,
Mike Gohlke
President,
American
Pharmacies |
| Order next season's flu vaccine NOW
|
This flu season caught our patients'
attention with more urgency than we've seen in
years. Of course, most of that was in regard to
H1N1, but the idea of getting any flu vaccine is
more important to most people.
Did you have
any trouble getting an adequate and timely
seasonal vaccine inventory this year? Help avoid
that problem in the 2010-2011 season by ordering
now.
My Flu Vaccine is a program of FFF
Enterprises, a nationwide vaccine distribution and
biopharmaceutical supplier. Their Web site, www.MyFluVaccine.com, is
virtually a one-stop shop for everything from the
vaccines to brochures and talking points to use
when answering patient questions.
Click here for an order form
on the American Pharmacies Web site.
The
company offers:
- multiple presentations by the
top manufacturers
- choose your delivery
date
- no
prepayment
Their
phone number is (800)
843-7477.
|
You'll never
run out of stamps!
USPS may use community business
locations
|
|
The United States Postal
Service is looking at options to reduce costs and
improve efficiency. One suggestion is to expand
the availability of postal services through other
community business. And what could be better than
through a community pharmacy?!
Some
community pharmacies already offer this service.
The National Community Pharmacists Association is
visiting with the USPS about continuing its
partnership with community pharmacies and possibly
expanding it.
Would you like to have a
post office in your
store?
|
Caterpillar
crawls to Walgreens & Walmart
|
The giant equipment maker Caterpillar
is creating an incentive-based prescription drug
plan for their employees with Walgreens and
Walmart. The National Community Pharmacists
Association is working with members of Congress
from Illinois to seek their help in reversing
Caterpillar's decision. NCPA sent a follow
up letter to senior executives at CAT urging them
to include independents in their employee
prescription plan as soon as
possible.
| |
Members
only
|
 Expert business
advice for APRx
stockholders
- Medicaid Integrity Program
provider audits
- Complaints
made against you to the Texas State Board of
Pharmacy
- The
independent pharmacist's duty to warn
- Auditing
loopholes in Medicare Part D
- Safeguard
your business from employee fraud
- Hiring
and firing tips
- The
pharmacist's guide to on-site audits
- Contracting
tips for independent
pharmacists
APRx members, go to Contact us section of APRx Web
site. In the "comments" section, type in your
preferred
password.
| | |
|
Dividends
&
Rebates |
|
If you would like to become
an American Pharmacies stockholder to
receive extra $$$, contact an American
Pharmacies business development
manager.
North
Texas
972.523.2064
ee
ee
aa
Kaye Stroud
South
Texas 512.623.9900
Most recent
stockholder distributions
Source
/Date
Morris
& Dickson / 21Jan 10
AmerisourceBergen / 19
Jan
10
|
| Your
APRx board |
Vance
Oglesbee, RPh
Chairman
Robert Kinsey,
RPh
Vice Chairman
Bruce Rogers,
RPh
Secretary/Treasurer
Lynn Everett,
RPh
Immediate Past Chairman
DIRECTORS
Ray Carvajal,
RPh
Buddy de la Rosa,
RPh
Alton Kanak,
RPh
Michael Muecke,
RPh
Dennis Song,
RPh |
| |
