Included in this newsletter
- e-Script Fraud Alert
- CMS Updates Definitions for Inpatient and Outpatient Hospital Status
- Cyberattack Update: NCPA Joins NACDS to Push HHS to Exempt Pharmacies from Breach Notifications
- States Expanding Pharmacist Scope of Practices
- Medicare Part B and PECOS
- Alisa Isenberg Promoted to Operations Manager
- Compliance Portal Updates
- Important Reminders for Your EDI Enrollment
- Enforcement
- R.J. Hedges Bulletin Releases/Webinars/Podcasts
- New & Updated Policies & Procedures
- New & Updated Forms & Support Documents
- Meet our Staff- Anne
DEA Regulation Changes
Several staff members had the opportunity to attend a DEA training on e-Prescribing Fraud. Unfortunately, it wasn't recorded, and they didn’t provide slides, but we wanted to share the DEA has identified a major security issue with eScripts for Controlled Substances.
The eScript system was designed to be more secure than traditional paper prescriptions. Unfortunately, bad actors have found a way to gain access to the eScript system to fraudulently process prescriptions by first creating fraudulent Electronic Health Record (EHR) accounts with real physician information.
The EHR companies use a vendor to certify and verify the physician called “proofing”, however, the bad actors have found a way to trick the “proofing” process. They are then awarded a EHR account and have full ability to issue what look like valid prescriptions. The DEA has found many instances where hundreds of prescriptions are being sent out from 1 practitioner. They did point out, that under closer examination- things don’t add up.
Example a pharmacy received a CII prescription for a non familiar 60+ YO patient from a non familiar prescriber. When they researched the prescriber, he was a Neonatal Surgeon at a hospital in another state. The red flag was raised by the pharmacist and the DEA discovered hundreds of fraudulent prescriptions were sent out to many other pharmacies.
The DEA is asking for help validating eScripts and not to automatically trust the e-prescription is valid. They are asking pharmacists to verify physicians especially if not local, and to verify patients using proof of identity at the time of dispensing. We recommend pharmacy staff follow the Controlled Substances policy and procedure in the DEA program.
CMS Updates Definitions for Outpatient Hospital Status
Inpatient status now ends “the day before the patient is discharged”. This solves so many audit issues that the pharmacy and DME no longer need to figure out the patient’s status of when they are a Part A verses a Part B patient.
https://www.medicare.gov/what-medicare-covers/what-part-a-covers/inpatient-or-outpatient-hospital-status
Cyberattack Update: NCPA Joins NACDS to Push HHS to Exempt Pharmacies from Breach Notifications
NCPA joined NACDS in submitting comments to the Department of Health and Human Services urging the agency to require Change Healthcare and UnitedHealth Group to make any breach notifications relating to the recent cyber-attack, not pharmacies and other downstream victims of this attack unless such victims otherwise elect to provide notice themselves. “We believe that requiring pharmacies to report breach notifications in these situations will perplex patients and add needless expenses to pharmacies, who have suffered greatly from this attack,” NCPA and NACDS wrote in the May 6 letter. Read the letter in full here and stay tuned to qAM for more on the fallout from the February cyber-attack.
States Expanding Pharmacist Scope of Practices
Many states are now expanding the pharmacist roles in healthcare, such as prescribing medications, providing clinical services, dispensing all 44 vaccines, except for Yellow Fever, and changing pharmacists from supplier to prescriber, among others. These services are critically needed for patients to access their healthcare services as the shortage of physicians continues to grow. There are still many states that have not expanded the pharmacists' roles in healthcare. In these states, work with the state pharmacist association, the state board of pharmacy, and the state legislatures.
Medicare Part B and PECOS
Attention all Pharmacy, Compounding and DMEPOS Clients: There are some vendors who are doing Medicare applications for a fee, plus adding additional fees to update the PECOS enrollment status. We want to remind everyone that R.J. Hedges & Associates provides CMS 855B and CMS 855S PECOS applications as part of our compliance package services at no fee for the application or any updates.
If you are working with a vendor who wants to be your surrogate on PECOS, then we cannot make any changes or handle your revalidations. If a vendor wants to change your PECOS surrogate to them, please understand that action will remove R.J. Hedges from access and the fees they charge will apply. When in doubt, contact your Project Manager through the Compliance Portal’s® Ticket System.
Please note, we do charge for our Medicare Application services as a stand alone product, and as an option for our a la carte clients.
Alisa Isenberg Promoted to Operations Manager
We have promoted Alisa Isenberg to our Operations Manager. Alisa is a driving force of our company, and she is also known affectionately as the “Office Mom.” We are excited to see her grow within our company and looking forward to her growth in this new role.
Compliance Portal Updates
We apologize for the Background Check feature being unavailable. US ISS updated some security measures on their end, and we experienced a few hiccups during the integration process.
Looking ahead they will be moving to a new platform this summer and we may have another period of time the system is offline while the integrations are established.
Important Reminders for Your EDI Enrollment
When completing the electronic data interchange (EDI) Enrollment application, the entity name and address you must enter on the EDI enrollment form match exactly the information contained in the CMS-855/PECOS enrollment application. If the name and address do not match, the EDI Enrollment will be denied.
What is the Entity Name?
- This is the exact provider’s name that was submitted in Section 2 of the CMS-855/PECOS enrollment application when applying to participate with Medicare.
What information should be put in the fields for Street Address, City, State, ZIP, Telephone Number, and Telephone Number Extension?
- The address must be an exact match of the physical practice address on file in Section 4 of the CMS-855/PECOS enrollment application. This may include suite/apartment, direction, or street/road designation. This is not an inclusive list. If there has been a change to the location of the provider, it must be submitted and approved on the CMS-855/PECOS application before submitting it on any EDI Requests.
Enforcement
- Staffing Company to Pay $2.7M for Alleged Failure to Provide Adequate Cybersecurity for COVID-19 Contact Tracing Data
- Doctor Sentenced for Unlawful Distribution of Oxycodone
- Note: this directly ties into the DEA and Pharmacy P&Ps on Controlled Substances and the pharmacy receiving the appropriate treatment plan.
R.J. Hedges Bulletin Releases/Webinars
New and Updated Policies & Procedures
Compounding-
- Procedures and Documentation
- Procedures and Documentation
New and Updated Forms & Support Documents
Compounding
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- Assessment of Risk Conventially Manufactured HD Products
- CNSP Complaint Record
Meet our Staff- Anne Jones
Meet Anne, our dedicated Accounting Specialist, whose passion for numbers is matched only by her love for family and adventure. Over the past nine years, Anne's has earned her bachelor’s in accounting and has been an asset helping with sales and our accounting tasks. Her keen eye for detail and dedication to accuracy ensure that financial matters are handled with precision and care. She also helps with our brokerage valuations.
Outside of work, Anne wears many hats, with her most important role being a great mom and devoted family chauffeur. From basketball to gymnastics, cheerleading to soccer, and everything in between, Anne ensures her daughters, Ragan and Delaney, are always where they need to be. Alongside her husband, Anne cherishes every moment spent hanging out with her kids, family, and friends, making memories that will last a lifetime.
While Anne admits her gardening skills may not be her strongest suit, she approaches it with enthusiasm and humor. Experimenting to see which plants survive her "not so green thumb" is all part of the fun.
As summer approaches, she eagerly anticipates a season filled with concerts, amusement park thrills, campfire stories, and beach days. Her creative talents extend to making fun birthday cakes for her girls and nieces; her flair for creativity shines through in every cake creation, making birthdays even more memorable.
Anne's journey at R.J. Hedges & Associates is a testament to her dedication, resilience, and passion for both her work and her family. We are privileged to have Anne as an integral part of our team, and we look forward to many more years of shared successes and joyful moments.
