Comments on: Certificates of Medical Necessity

By: DensityDuck

DensityDuck — Tue, 24 Jan 2012 18:56:26 +0000

Hey, this is what it costs to prove that you aren’t denying his Oxycontin script just because he’s black.

By: DefendUSA

DefendUSA — Fri, 20 Jan 2012 12:02:16 +0000

As an accountant’s spouse and office manager, and veteran, you have no idea! The way that all gov’t agencies operate is based on over-regulation and overlapping. It’s insane. Their budget processes suck and in any private business, whom ever would operate that way would fold in no time flat. It amazes me that people cannot understand how their tax dollars are spent and the absolute lack of fiduciary responsibility the government shows.
Not only that, but I KNOW that time equals money in our business and gov’t workers constantly pull the teat and when they’re done, they’re done. No late hours, no busting tail, no thinking required…not all… but the vast majority. And heaven help the out of the box thinker who finds a new more efficient way to do something…they’ll just waste the saved money on another redundant arm of consumption. Okay…getting off the soap box.

By: AnotherRose

AnotherRose — Thu, 19 Jan 2012 06:44:48 +0000

I’m a recent accounting grad with a job as a junior bean counter and oh how your analogy makes me laugh! Though, if I start to get these statements with the tax forms I send out I won’t know whether to laugh harder or sign them with an illegible scrawl and mail them back…

By: marcb

marcb — Thu, 19 Jan 2012 03:00:36 +0000

I have to say coming from the other end (the pharmacy) that getting all the crap for prior auths isn’t fun for us either especially when I have the patient pissed because XYZ insurance or medicaid won’t cover some medication. At least if the script the insurance wants a PA from is a PCP or specialist the person is seeing chronically then it doesn’t cost us much to fax a form over basically saying the insurance wants a PA, if you want to try and get one then here is the number to call. ER docs, hospitalists, and residents we don’t even bother with as it is a waste of our time and their time. I had to laugh one time when a patient demanded we call the resident to get a PA, the resident actually asked me: what a prior auth was and how long the pharmacy would take to get it filled out. He changed his tune for wanting brand name XYZ after learning that it was his duty to fill it out, not the pharmacist or pharmacy’s job. I also remember one patient getting cymbalta from a hospitalist because her previous rx had run out and was pissed state medicaid was not covering it without a PA, she seemed to think the hospitalist was going to whip up the PA at 7pm on a friday night so she could get the med right then and there, like that is going to happen; I think not.

By: Eric Atkinson

Eric Atkinson — Thu, 19 Jan 2012 02:40:12 +0000

Where do you buy stamps at? They cost me 48 cents.

By: dr. lasermed

dr. lasermed — Wed, 18 Jan 2012 21:13:47 +0000

Here’s an example of “Just a Medicine Refill” from my blog.
http://dr-lasermed.blogspot.com/2012/01/example-of-just-medicine-refill.html
Got me started thinking.

By: dr. lasermed

dr. lasermed — Wed, 18 Jan 2012 19:24:57 +0000

Most physicians write many prescriptions daily. Medicare, Medicaid and other insurance companies don’t even bother to check the patient’s diagnosis before automatically kicking back “prior authorizations” to the physician.

The amount of time that is wasted in
1. pulling the chart
2. matching it with the request
3. checking to see when the prescription was written and why
4. filling out the diagnosis and codes (which the insurance company already has if the claim for the visit was submitted)
5. signing the form
6. Making a note in the chart that you have done this
7. faxing the form
8. filing the form in the appropriate place
9. refiling the chart
10. doing this all again when the insurance company or pharmacy says they didn’t receive this the first time…..

AAAARGH – for this I went to school 12 years after high school?

By: David Wander

David Wander — Wed, 18 Jan 2012 19:07:37 +0000

Enforcement is often expensive. The fact that enforcing of regulations may cost more than the actual medication is only interesting if a) prescriptions were never being misused by physicians or b) even if they were, auditing and enforcing would be futile or c) there are much more efficient ways of enforcing than burdening doctors and pharmacies with paperwork.

It seems unlikely that the follow-up to pharmacy and physician is just random. Rather it’s likely that SOME physicians are prescribing OUTSIDE best practice guidelines, and yes, for “convenience.”

It also seems likely that some method of enforcement to reduce unnecessary and unjustified costs is proper. The real question is how to do it.

By: Bloodshot

Bloodshot — Wed, 18 Jan 2012 18:59:39 +0000

Not sure if it would work (I wouldn’t hold my breath), but it *would* show you have titanium nerves and balls of steel!

By: throckmorton

throckmorton — Wed, 18 Jan 2012 16:55:58 +0000

Did that form come attached to the FMLA paperwork as well?