The Maximum Eventual Order Duration registry setting or Order Type extended attribute should be defined to provide enough time for the ordering practitioner to receive a Renew To Do in order to renew the myAvatar OE Order. For example, for Legend drugs you can define it as 335 instead of 365, for Controlled Substances C3-C5 you can define it as 150 instead of 180 and for C2 drugs you can just define it as 30 or less, since there is no refill allowed for these class of controlled substances. Following this method will provide the ordering practitioner enough time to receive a Renew To Do item (if configured) to remind them to renew an order that is expiring. If you wish for the Maximum Eventual Order Duration to be enforced then you should not enable Open Ended Orders per order type.
You should run the Compile Inbound HL7 Charge Batch File for the previous month at least 5-7 days AFTER the first Fill List is generated in the current month. This will ensure that credits applied late are included in the compiled file. The setting Match On Which Date When Applying Credits should be set to Any. A change is logic was implemented to allow the system to include any credit where the credit data is no more than 15 days past the batch ‘through’ date to be included in the batch.
RxConnect
Physician Definition
RxConnect will automatically add any new physicians that enter orders. The physicians have unique codes assigned to them in the STAFF screen that should not be changed or removed under any circumstances. Changing this code or removing it will invalidate Medicare Part D billing. (Version 6.5 and higher of RxConnect no longer allows this identifier to be removed.)
Bill on Administration vs. Bill on Dispense
If the RxConnect system is set to bill on administration, then unit dose items will be billed when the administration is received by RxConnect. Bulk items will always be billed on dispense from the pharmacy because multiple administrations from one bulk medication are possible, and charging for the entire inhaler or cream is not appropriate. The Bill On Dispense setting means that all items will be billed when the item is dispensed from the pharmacy.
Items for which no administration can be received will always be billed on dispense. Examples of this are Manual Dispense items, Leave, and Discharge medications. In Order Tracking, you can easily see items that were dispensed pursuant to an order and when they were administered. You can also see when a billing record was created and when it was batched and sent.
Any time a medication will have more than one administration from the same dispense, the items MUST be a unit dose = NO (Bulk) medication as well. Examples are - inhalers, creams, ointments, and kits. Each of these examples will have more than one (possibly) administration from the single dispensed item. This would cause the item to be billed multiple times, which is not acceptable.
Should you discover that an item is being billed with each administration and this is not desired, you can reverse the charges and then change the unit dose flag in the Enterprise Template Screen, OR you can change the flag and reverse the charges directly from your billing system.
Cardinal Price File Update
It is imperative that the Cardinal Price file is installed into RxConnect and updated regularly. The price update file should contain the entire list of all items that have an NDC number from the wholesaler.
Switch Drug Routine
Sometimes you may have inactivated a drug template in the drug master file because you don't want anyone to use it anymore. You should first run the SWITCH DRUG routine to make sure that any patients on that template they are inactivating are switched to a new template medication.
If a template is inactivated, it will still be on orders and it will still use the last actual NDC number associated with that inactivated template.
Bulk Medication - RxConnect Version 6.3 will have the following functionality - the Hospital Configuration form has a default Bulk medications setting for Days Supply. This should be set at a relatively small number. Generally three to seven days. This means that unless the pharmacist overrides this setting for each dispense, the day's supply for a bulk medication will not be calculated like a unit dose medication is, it will be set to the default setting. Generally five days is enough. This means that if this setting is not overridden, the medication cannot be billed for again until five days (whatever was billed for) has expired.
On the Print Label screen, the pharmacist can indicate the number of day's supply that should be used on any dispense. The Print Label screen also displays the last time a medication was dispensed pursuant to this order so that it will be easy to catch early dispenses for bulk medications. The Patient Profile also shows the last date and time of dispense as well.
The Order Tracking screen also allows you to override and make manual dispenses as well.
How do we handle a lost medication or a dropped medication?
Recommendation - If the hospital is not going to get paid for this new dispense, it would seem that crediting and re-dispensing the item would be less than optimum. If the hospital is going to have to write off the charge anyway, it would be recommended simply to print a label and dispense the next one at no charge.
The hospital is free to credit any dispense at any time.
We have a missing provider on some charges.
Recommended practice: prior versions of RxConnect allowed you to remove a payer's code and then inactivate them. This is no longer allowed as this can lead to a null provider code for all orders where the practitioner that was inactivated was used. If this is occurring, make sure that you are on Version 6.3 or higher of RxConnect. If you have, then this should be reported to technical support.
We are having charges that are 0.00 coming across to be billed.
Recommendation - The site must absolutely have an entire load of their wholesaler prices uploaded every month. If the entire load is accomplished and all medications are purchased through the wholesaler, it is no longer possible to have a 0.00 charge.
Monitor all manual changes of NDC numbers and make sure that none are selected that have 0.00 cost or AWP.
Monitor the RxSummary Alerts tab for items dispensed with no cost.
How can we handle half tablet dispensing?
We find that a 40 mg tablet might be $100 per tablet and 20 mg tablets are also $100 per tablet. In this case we can save significantly by cutting the tablet (40 mg) in half and dispensing as two 20 mg tablets.
Recommendation - We recommend that the pharmacy staff use a Manual Dispense for all half tablets. This means that, when coding, the pharmacist should use the pull down on the right side and select None Specified.
This will make the order essentially an OUTPATIENT order and nothing will be dispensed on the fill list for it. The pharmacy will need to handle all dispenses manually, BUT they can code the order as the 40 mg and indicate giving a half tablet. They can then manually dispense half of the usual dose - so if this is a 28 day fill for a daily medication, they can send 14 tablets. They can cut them in half themselves, or let the nurse do it, or package them any way that they wish.
The system will bill for 14 tablets of the 40 mg tablet and it will be a 28 day (or 30 day if they sent 15) supply.
Regarding notification - usually prescriptions have the nurse notify the pharmacy when more is needed like all outpatient prescriptions, but the pharmacy would be able to keep their own refill records as well.
Non-Redbook Drugs: (Non-Redbook Drugs are not supported for NCPDP billing)
Recommendation - The pharmacy should use the format 99999-9999-99 when creating an NDC number in non-redbook. The pharmacy should always use five "9"s for the first section. The next four digits and the last two should be assigned by the pharmacy. They should keep a listing of the last number used and always use a number one higher for the next non-redbook item created. If the format is not 5-4-2, the billing system will refuse to try and bill for the item. While this will do all of the billing correctly for the patient's ledger, myAvatar will not be able to bill non-redbook items using NCPDP for Medicare Part D. Please check to see if this can be billed through Medicare Part D.
We have instances where the NDC number is not correct.
Recommendation - Sometimes you may inactivate a drug template in the drug master file because you don't want anyone to use it anymore. You should first run the SWITCH DRUG routine to make sure that any patients on that template being inactivated are switched to a new template medication.
If a template is inactivated, it will still be on orders and it will still use the last actual NDC number associated with that inactivated template.
Problem - The NDC number desired can be seen but it will not save it. When we come back to the drug master file, it has changed back to another number.
REASON: Inventory shows that the drug is available in inventory so the NDC isn't saving. RxConnect sees that drugs are available.
Inventory states 8000+ items. Admin entered inflated drug inventory so drugs could be transferred.
Inventory will overwrite by default and can't change NDC.
BEST PRACTICE: Need to update inventory and have it accurate and the NDC number will change automatically as inventory is relieved.
How can we know what drugs are inactive that have patient orders on them.
Response: Netsmart has a Crystal report that can be downloaded from the Netsmart Wiki and run that will tell you what inactive templates are being used on active orders.
How can we manually enter the Days Supply on Bulk Medications?
There are only two places where the user can manually dispense bulk medications. Order Tracking and Print Screens.
The Order Tracking field:
Enter the number of items to dispense and enter the days supply for this medication and then click on the POST button. The Print Labels screen have the Days Supply immediately above the RUN button on all screens.
It is NOT necessary to click on the CALC button. The number of days in both screens should simply be entered and then click on the desired button.
