Proof of Patient Counseling Required!
Pharmacies are familiar with submitting copies of prescriptions, signature logs and proof of copay collection upon an audit request, but do you have documented proof of the offer to counsel? While the patient can accept or refuse counseling, it must be documented for Medicaid patients. PAAS National®® analysts often see pharmacies with these requests during Medicaid (Payment Error Rate Measurement) audits, and pharmacies must include this documentation along with their other audit materials. Additionally, proof of patient counseling, or the offer to counsel, may be required during the credentialing process for Medicaid Managed Care programs. This requirement stems from the Omnibus Budget Reconciliation Act of 1990 (OBRA ’90), as outlined in 42 CFR §456.705. OBRA ’90, along with CMS regulations, mandates that states establish patient counseling standards for Medicaid programs in order to receive federal funding. While OBRA ’90’s primary objective was to save the federal government money through improved therapeutic outcomes, it achieved this by requiring pharmacists to offer counseling, conduct prospective drug utilization reviews (ProDUR), and maintain thorough records.
PAAS Tips:
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- Establish a process to document the acceptance or refusal of counseling
- Check with your State Board of Pharmacy and Medicaid Agency for compliance regulations as these can vary by state
- Have a process in place to ensure compliance when the patient is not present in the pharmacy
- Ex: Mailed or delivered prescriptions should, at a minimum, include a toll-free number for patients to call the pharmacist for consultation
- Pharmacies should also address how to safely provide counseling to limited English proficient (LEP) patients that speak other languages
- Learn more about providing linguistically appropriate services to patients in PAAS’ Cultural Competency Training
- For pharmacies using electronic signature capture, reach out to your software vendor and request that documentation of the offer to counsel be added for all prescriptions during the check-out process
- For pharmacies using paper signature logs, be sure the offer to counsel is being captured
- PAAS offers a printable signature logbook on our portal which contains an “offer to counsel” column for refusal or acceptance
- Confirm acceptance, or refusal, of counseling is readily available to print in case of an audit or inspection
- To keep it simple, PAAS recommends documenting the offer to counsel for all patients as one standard of pharmaceutical care
I have a Bachelor of Science degree from the University of Wisconsin-River Falls and have been a Certified Pharmacy Technician since 2001. Prior to joining the PAAS team, I was a floating technician, 3rd party district chargeback specialist, and district pharmacy training coordinator. Formerly, I was also an instructor for pharmacy technician certification classes.
PAAS’ personal, one-on-one connection will help your pharmacy become more successful in dealing with tiresome PBM audits. It is a pleasure knowing that my colleagues and I can help member pharmacies.
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