Allwin Medicare Part B Billing Manual

Transcription

1 Allwin Medicare Part B Billing Manual Revised

2 Table of Contents How to Run Prescriptions on Allwin Allwin Form Allwin Form Example Statement to Permit Payment of Medicare Benefits to Provider and Patient Advanced Beneficiary Notice (ABN) Information ABN Form Certificate of Medical Necessity Information CMN Form Proof of Delivery Form Medicare DMEPOS Supplier Standards Customer Satisfaction Survey HIPAA Notice of Privacy Practices Medicare Billing Terms Medicare Forms and Retention Brookshire Brothers Assignment Lists Not Covered on Medicare Part B Allwin Dispensing & Supplying Fees Allwin Online Login DMEPOS Dispensing Incidents Allwin Secondary Insurance COBA (Coordination of Benefits Agreement) list Medicare Reference Guide 2

3 How to Run Prescriptions on Allwin 1. Have the patient fill out all required documentation and obtain a copy of the patient's Medicare card. Keep these on file in the pharmacy for 10 years. a. Allwin Form Complete for each new prescription. b. Statement to Permit Payment of Medicare Benefits to Provider and Patient Complete for each new prescription. c. Advance Beneficiary Notice (ABN) Complete this form anytime there is doubt about a product being covered or if the allowance has been used for a product. d. Certificate of Medical Necessity (CMN) Complete this form when a patient s utilization exceeds Medicare s guidelines. e. All patients should be given a copy of the Medicare DMEPOS Supplier Standards and Notice of Privacy Practices. f. All patients should complete the Medicare Customer Satisfaction Survey. 2. Fax the completed Allwin Form to the doctor s office to get their section filled out. 3. Once we receive that information back from the doctor, we input the prescription using the below third party billing information: Condor Pharmacies: Third Party Code: 204 ID: (Medicare # off of their Medicare card with a A or B on the end) Example: A or B Group: 03 Person Code: (none needed) Etreby Pharmacies: Bill code: ALLWIN D (Assigned) Group: (none needed) ID: (patient's Medicare # off of their Medicare card) Once all of this information is input and the prescription is typed up, you will need to input the diagnosis code (if applicable) (ETREBY on the More tab) for the patient s prescribed diagnosis and finish filling the prescription. Please call the Brookshire Brothers Computer Help Desk with any rejected claims or questions at Extension: If not available please contact the Allwin Help Desk at

4 Please Complete the Following Information Legibly: Date Filled: Brookshire Brothers Pharmacy Instructions for Patients Eligible for Medicare Patient Name: Date of Birth: Street Address: City: State: Zip: Patient ID Number (Medicare Number): /Effective Date: Patient Social Security Number: Sex: Male Female This equipment is: Rented Purchased For Home Use Already Patient Owned Pick Up Date: Has Patient had this particular product in the past? If so, when and how long: I agree to pay charges or copays not covered by Medicare. I also understand that I am responsible for damages to Rental Equipment outside of normal wear & tear. Patient Signature: Date: Diagnosis/Diagnosis Code This patient needs the following equipment/drug(s)/diabetic supply(s) for the stated time period: Effective Date Number of Months Procedure Code Description Please write below a description of the item including: Name, Concentration (if applicable), Dosage, and Frequency of Administration of Drug, Method Administration must be given and Duration of Infusion (if applicable): I, the undersigned, certify that the above prescribed DME/ drug(s)/diabetic supply(s) is medically necessary as part of my treatment for accepted standards of medical practice and treatment of this patient s condition and has not been prescribed as convenience equipment. Physician s Signature Date: Physician Name: Address: City: State: Zip: UPIN # Phone Number: Please fax this form back to Brookshire Brothers Pharmacy at () -when completed. 4

5 Brookshire Bros. Pharmacy Instructions for Patients Eligible for Medicare EXAMPLE Please Complete the Following Information Legibly: Date Filled: Patient Name: PATIENT INFORMATION Date of Birth: Street Address: City: State: Zip: Patient ID Number (Medicare Number): NEED COPY OF MEDICARE CARD Effective Date: on medicare card Patient Social Security Number: sometimes different from medicare# (helpful to have this information Sex: Male Female As a general rule merchandise more than $ is rental, less than $ is purchase only This equipment is: Rented Purchased For Home Use Already Patient Owned Pick Up Date: Has Patient had this particular product in the past? If so, when and how long: I agree to pay charges or copays not covered by Medicare. I also understand that I am responsible for damages to Rental Equipment outside of normal wear & tear. Patient Signature: need patient s signature Date: Diagnosis/Diagnosis Code: _this can be the DX code or a description of DX This patient needs the following equipment/drug(s)/diabetic supply(s) for the stated time period: Effective Date Number of Months Procedure Code Description Date on this is the estimated time Prescription rental property will be used HCPC Code-product ID# Please write below a description of the item including: Name, Concentration (if applicable), Dosage, and Frequency of Administration of Drug, Method Administration must be given and Duration of Infusion (if applicable): I, the undersigned, certify that the above prescribed DME/ drug(s)/diabetic supply(s) is medically necessary as part of my treatment for accepted standards of medical practice and treatment of this patient s condition and has not been prescribed as convenience equipment. Physician s Signature: if discharge orders are signed put SEE ATTACHED Date: Physician Name: Address: City: State: Zip: UPIN # physician s number Phone Number: Please fax this form back to Brookshire Brothers Pharmacy at () -when completed. 5

6 Statement to Permit Payment of Medicare Benefits to Provider and Patient Beneficiary Name HICN I request that payment of authorized Medicare benefits be made either to me or on my behalf for any services furnished me by or in. I authorized any holder of medical or other information about me to release to the Center of Medicare & Medicaid Services and its agents any information needed to determine these benefits for related services. Item(s) /Service(s) Provided Beneficiary Signature Date 6

7 Advanced Beneficiary Notice (ABN) Information If you are not sure if a Medicare patient has exhausted their allowance for equipment make sure that this sheet is filled out prior to submitting the claim. You will have to contact the pharmacy help desk for them to enter the GA modifier. This number will tell Allwin to check and see if the patient has used their allowance. Make sure that the patient understands that if they have used their allowance for the product they will then have to pay cash. If we are taking assignment on a product, it is very important to have this paper filled out or we are responsible for the product and its cost. If in doubt about a product being covered or if the allowance has been used for a product, make sure that you get the ABN filled out. Medicare Allowances on Common Durable Medical Equipment: Glucometer: 1 glucometer every year Nebulizers: 1 nebulizer every 3 years 7

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9 Certificates of Medical Necessity & DMERC Information Forms When a patient is testing over Medicare s guidelines on diabetic supplies, Allwin will reject the claim and tell the pharmacy that Utilization exceeds <amt>/<days>. If the prescription specifies frequency, indicate medical necessity with 07 in Rx Denial. If the prescription does specify the frequency on the claim, the pharmacy should enter the 7 in the Rx Denial (Submission Clarification Code) field which prompts Allwin to generate a narrative statement to go along with the claim that indicates that the physician requested testing times per day ( comes from quantity/days supply). Furthermore, if an item requires a Certificate of Medical Necessity, DMERC Information Form or narrative statement Allwin will always reject it and require that the pharmacy submit the requested information. A DIF is a DMERC Information Form or DME MAC Information Form, it s similar to a CMN however, a DIF can be completed in its entirety by the supplier (pharmacy) as no physician involvement is required (not even signature). Currently the only items that require a DIF are parenteral / enteral nutrition and external infusion pumps. 9

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11 Medicare Part B Proof of Delivery Date of Delivery: Beneficiary s Name: Relationship to Beneficiary (check one): Self Spouse Other Description of Item: Brand Name of Item: Quantity Delivered: Item Serial Number (if applicable): Beneficiary/Designee Signature: Adapted from DME MAC Jurisdiction C Supplier manual Ch. 3 p.14 Created by Michael Willett, RPh 04/21/

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14 Customer Satisfaction Survey Patient Name: Date of Service: Equipment Prescribed: Questionnaire 1. Are you satisfied with the equipment/supplies? Yes No N/A 2. Were your equipment/supplies delivered in a timely manner? Yes No N/A 3. Were the equipment/supplies ready for use upon delivery? Yes No N/A 4. Did you receive instructions on how to properly use your equipment/supplies? Yes No N/A 5. Did you receive information on how to inquire about complaints and billing issues? Yes No N/A 6. Would you recommend the service you received to others? Yes No N/A 7. Are you satisfied to the responses to any questions, concerns, or problems? Yes No N/A a. Was this response timely? Yes No N/A 14

15 NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. Brookshire Brothers Ltd. is required by law to maintain the privacy of Protected Health Information ( PHI ) and to provide individuals with notice of our legal duties and privacy practices with respect to PHI. PHI is information that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. This Notice of Privacy Practices ( Notice ) describes how we may use and disclose PHI to carry out treatment, payment or health care operations and for other specified purposes that are permitted or required by law. The Notice also describes your rights with respect to PHI about you. Brookshire Brothers Ltd. is required to follow the terms of this Notice. We will not use or disclose PHI about you without your written authorization, except as described in this Notice. We reserve the right to change our practices and this Notice and to make the new Notice effective for all PHI we maintain. Upon request, we will provide any revised Notice to you. Your Health Information Rights You have the following rights with respect to PHI about you: Obtain a paper copy of the Notice upon request. You may request a copy of the Notice at any time. Even if you have agreed to receive the Notice electronically, you are still entitled to a paper copy. To obtain a paper copy, contact your local Brookshire Brothers Pharmacy or you may send a written request to: Privacy Officer, Brookshire Brothers Ltd., P.O. Box 1688, Lufkin, TX Request a restriction on certain uses and disclosures of PHI. You have the right to request additional restrictions on our use or disclosure of PHI about you by sending a written request on the standard Request for Additional Privacy (available at your local Brookshire Brothers Pharmacy) form to: Privacy Officer, Brookshire Brothers Ltd., P.O. Box 1688, Lufkin, TX We are not required to agree to those restrictions. Inspect and obtain a copy of PHI. You have the right to access and copy PHI about you contained in a designated record set for as long as Brookshire Brothers Ltd. maintains the PHI. The designated record set usually will include prescription and billing records. To receive a summary of PHI about you contact your local Brookshire Brothers Pharmacy. To inspect or copy detailed PHI about you, you must send a written request on the standard Request for Access form (available at your local Brookshire Brothers Pharmacy) to: Privacy Officer, Brookshire Brothers Ltd., P.O. Box 1688, Lufkin, TX We may charge you a fee for the costs of copying, mailing and supplies that are necessary to fulfill your request. We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to PHI about you, you may request that the denial be reviewed. Request an amendment of PHI. If you feel that PHI we maintain about you is incomplete or incorrect, you may request that we amend it. You may request an amendment for as long as we maintain the PHI. To request an amendment, you must send a written request on the standard Request for Amendment form (available at your local Brookshire Brothers Pharmacy) to: Privacy Officer, Brookshire Brothers Ltd., P.O. Box 1688, Lufkin, TX You must include a reason that supports your request. In certain cases, we may deny your request for amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with the decision and we may give a rebuttal to your statement. Receive an accounting of disclosures of PHI. You have the right to receive an accounting of the disclosures we have made of PHI about you after April 14, 2003 for most purposes other than treatment, payment, or health care operations. The accounting will exclude certain disclosures, such disclosures made directly to you, disclosures you authorize, disclosures to friends or family members involved in your care, and disclosures for notification purposes. The right to receive an accounting is subject to certain other exceptions, restrictions, and limitations. To request an accounting, you must submit a request in writing on the standard Request for Accounting form (available at your local Brookshire Brothers Pharmacy) to: Privacy Officer, Brookshire Brothers Ltd., P.O. Box 1688, Lufkin, TX Your request must specify the time period for which you wish an accounting, which may not be longer than six years. The first accounting you request within a 12 month period will be provided free of charge, but you may be charged for the cost of providing additional accountings. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time. Request communications of PHI by alternative means or at alternative locations. For instance, you may request that we contact you about medical matters only in writing or at a different residence or post office box. To request confidential communication of PHI about you, you must submit a request in writing on the standard Request for Additional Privacy form (available at your local Brookshire Brothers Pharmacy). All completed forms must be submitted in person at your local Brookshire Brothers Pharmacy. Your request must state how or where you would like to be contacted. We will accommodate all reasonable requests. In the event of an emergency regarding your treatment, if we cannot reach you promptly using the alternative means or alternative location you requested, we may try to reach you by other means or at another location. Examples of How We May Use and Disclose PHI Subject to applicable Texas law, a description of which is appended to this Notice, the following are descriptions and examples of ways we use and disclose PHI: We will use PHI for treatment. For example, information obtained by the pharmacist will be used to dispense prescription medications to you, and may be used to monitor the effectiveness, safety, and compliance of your drug therapy. In addition, we may contact you to provide refill reminders, information about treatment alternatives, educational information about current or new therapeutic products, or information about other health-related benefits and services that may be of interest to you. We will document in your record information related to the medications dispensed to you and services provided to you. We will use PHI for payment. For example, we will contact your insurer or pharmacy benefit manager to determine whether it will pay for your prescription and the amount of your copayment. We will bill you or a third-party payor for the cost of prescription medications dispensed to you. The information on or accompanying the bill may include information that identifies you, as well as the prescriptions you are taking. We will use PHI for health care operations. For example, Brookshire Brothers Ltd. may use information in your health record to monitor the performance of the pharmacists providing treatment to you. This information will be used in an effort to continually improve the quality and effectiveness of the health care and service we provide. Subject to applicable Texas law, a description of which is appended to this Notice, we also are permitted or required to use or disclose PHI for the following purposes; however, some of these disclosures may never occur at our pharmacies. Business associates: There are some services provided by us through contracts with business associates. For example, we may contract with a third party to perform Medicare Part B billing services for us. We may disclose PHI about you to our business associate so that they can perform the job we have asked them to do and bill you or your thirdparty payor for services rendered. To protect PHI about you, we require the business associate to appropriately safeguard the PHI. Communication with individuals involved in your care or payment for your care: Health professionals such as pharmacists, using their professional judgment, may disclose to a family member, other relative, close personal friend or any person you identify, PHI relevant to that person s involvement in your care or payment related to your care. 15

16 Food and Drug Administration (FDA): We may disclose to the FDA, or persons under the jurisdiction of the FDA PHI relative to adverse events with respect to drugs, foods, supplements, products and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement. Worker s compensation: We may disclose PHI about you as authorized by and as necessary to comply with laws relating to worker s compensation or similar programs established by law. Public health: As required by law, we may disclose PHI about you to public health or legal authorities charged with preventing or controlling disease, injury, or disability. Law enforcement: We may disclose PHI about you for law enforcement purposes as required by law or in response to a valid subpoena or other legal process. As required by law: We must disclose PHI about you when required to do so by law. Health oversight activities: We may disclose PHI about you to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, and inspections, as necessary for our licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws. Judicial and administrative proceedings: If you are involved in a lawsuit or a dispute, we may disclose PHI about you in response to a court or administrative order. We may also disclose PHI about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the requested PHI. Research: We may disclose PHI about you to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your information. Coroners, medical examiners, and funeral directors: We may release PHI about you to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also disclose PHI to funeral directors consistent with applicable law to carry out their duties. Organ or tissue procurement organizations: Consistent with applicable law, we may disclose PHI about you to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant. Notification: We may use or disclose PHI about you to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and your general condition. Correctional institution: If you are or become an inmate of a correctional institution, we may disclose PHI to the institution or its agents when necessary for your health or the health and safety of others. To avert a serious threat to health or safety: We may use and disclose PHI about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Military and veterans: If you are a member of the armed forces, we may release PHI about you as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate military authority. National security and intelligence activities: We may release PHI about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. Protective services for the President and others: We may disclose PHI about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations. Victims of abuse, neglect, or domestic violence: We may disclose PHI about you to a government authority, such as a social service or protective services agency, if we reasonably believe you are a victim of abuse, neglect, or domestic violence. We will only disclose this type of information to the extent required by law, if you agree to the disclosure, or if the disclosure is allowed by law and we believe it is necessary to prevent serious harm to you or someone else or the law enforcement or public official that is to receive the report represents that it is necessary and will not be used against you. Other Uses and Disclosures of PHI Brookshire Brothers Ltd. will obtain your written authorization before using or disclosing PHI about you for purposes other than those provided for above or as otherwise permitted or required by law. You may revoke an authorization in writing at any time. Within five (5) days of the receipt of the written revocation, we will stop using or disclosing PHI about you, except to the extent that we have already taken action in reliance on the authorization. Brookshire Brothers Ltd. Employees We may disclose PHI about you for a work-related illness or injury or a workplace-related medical surveillance. Minors If you are a minor who has lawfully provided consent for treatment and you would like Brookshire Brothers Ltd., to the extent permitted by your state s laws, to treat you as an adult for purposes of access to and disclosure of records related to such treatment, please notify the pharmacist. For More Information or to Report a Problem If you have questions or would like additional information about the Brookshire Brothers Ltd. privacy practices, you may contact the Privacy Officer at Brookshire Brothers Ltd., P.O. Box 1688, Lufkin, TX 75901, (936) If you believe your privacy rights have been violated, you can file a complaint in writing by submitting a standard Complaint form (available at your local Brookshire Brothers Pharmacy) to the Brookshire Brothers Ltd. Privacy Officer or in writing to the Secretary of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C There will be no retaliation for filing a complaint. Effective Date This Notice is effective as of April 14, Texas Law Addendum The following requirements modify the listed Examples of How We May Use and Disclose PHI, except as otherwise permitted or required by law: We will only release your confidential record to you, your agent, or to: (a) a practitioner or another pharmacist if, in the pharmacist s professional judgment, the release is necessary to protect your health and well being; (b) the pharmacy board or another state or federal agency authorized by law to receive the record; (c) a law enforcement agency engaged in investigation of a suspected violation of the controlled substances laws, or the Comprehensive Drug Abuse Prevent Control Act of 1970; (d) a person employed by a state agency that licenses a practitioner, if the person is performing the person s official duties; or an insurance carrier or other third party payor authorized by the patient to receive the information. 16

17 Medicare Billing Terms HCPC: This is the number used by Medicare to identify a product. (Example: HCPC for Nebulizer is E0570) NPI#: National Provider Identification Number this number is unique to each provider (doctors, pharmacies, etc). HICN: This is the patient s Medicare ID number including letters. NSC#: This is the pharmacy s supplier or Medicare number and is unique to each store. Assigned: The claim will process as assigned and any reimbursement will be sent to the provider (20% or $0.00 patient pay amount depending on an indication of supplemental insurance). Unassigned: The claim will process as unassigned and any reimbursement will be sent to the beneficiary (100% patient pay amount equal to the U&C). ****Almost everything we fill is going to be assignment.**** 17

18 Medicare Forms and Retention Allwin Form Complete this form for each new prescription. Must keep on file in pharmacy for 10 years. Statement to Permit Payment of Medicare Benefits to Provider and Patient Complete this form for each new prescription Must keep on file in pharmacy for 10 years. Advance Beneficiary Notice (ABN) Complete this form anytime there is doubt about a product being covered or if the allowance has been used for a product. Must keep on file in pharmacy for 10 years. Certificate of Medical Necessity (CMN) Complete this form anytime the customer s utilization exceeds Medicare s guidelines. Must keep on file in pharmacy for 10 years. Medicare Customer Satisfaction Survey All patients should complete a Medicare Customer Satisfaction Survey. Must keep on file in pharmacy for 10 years. Refill Documentation Documentation of refill requests (by the patient) must be kept on file for all Medicare Part B DMEPOS prescriptions. Etreby Medicare Part B DMEPOS prescriptions may NOT be signed up for automatic refilling. Additional Information can be found at: ions/whatsnew/dmemacnews08/ngs_032509_bene_refill.aspx 18

19 Brookshire Brothers Assignment Lists Accept Assignment Processor Control Number: USMCA Condor Third Party ALLWIN D (Assigned) Etreby Third Party Run the below items on assignment: Drugs Oral Immunosuppressives Oral Anticancer Oral Antiemetic Inhalation drugs administered through a nebulizer Epotein-Aplha/Darboetein-Alpha Drugs Certain drugs, including insulin, administered through an External Infusion Pump (EIP) DME Diabetic supplies, including strips, lancets, and monitors Ostomy Supplies Urological Supplies Surgical Dressings Enternal Nutrition administered through a G-Tube Seat-lift mechanisms Walkers / Canes / Crutches Diabetic Footwear Prosthetics and Orthotics If what you are billing is not on the above lists (Drugs and DME) do not accept assignment. Bill it as unassigned. The customer pays 100 % of the amount when billed as un-assigned. Un-Assigned Processor Control Number: USMCANON Condor Third Party ALLWIN D (Unassigned) Etreby Third Party 19

20 Not Covered on Medicare Part B Pen Needles, Epi-Pens, Insulin Pens Diapers, briefs, and incontinence pads Syringes Any inhalation drug administered via MDI Spacer for use with an MDI Compression Stockings Alcohol Swabs Surgical Gloves Blood Pressure Monitor Bathtub Lifts/ Seats/ Stools/ Benches/ Rails Insulin administered through a syringe 20

21 Allwin Dispensing & Supplying Fees Allwin will pay You a fee of Supplying Fees For immunosuppressive drugs, oral anti-cancer chemotherapeutic drugs, anti-cancer chemotherapeutic regimen and oral anti-emetic drugs used as part of a chemotherapeutic regimen. Initial fill for an immunosuppressive drug $50.00 (one time) First prescription in a 30 day period $24.00 (If any of the above drugs are dispensed during a 30 day period you will be eligible for one $24 supplying fee in that period. (If less than 30 days since last fill, the dispensing fee will not be paid). Each subsequent prescription of the above listed drugs in the $16.00 same 30 day period. (If less than 30 days since last fill, fee will not be paid). Dispensing Fees For inhalation drugs Initial dispensing fee for inhalation drugs $57.00 (one time) 30-day period of Inhalation drugs $33.00 (if less than 30 days since last fill, the dispensing fee will not be paid). 90-day period of Inhalation drugs $66.00 (if less than 90 days since last fill, the dispensing fee will not be paid). No codes needed. Allwin/eRx Network, an Emdeon Company, Brookshire Brothers Medicare Part B billing agent, has all applicable Medicare policy, formatting requirements and current pricing information loaded into their system. They also have access to Medicare s real time 270/271 eligibility server. When Brookshire Brothers submit claims to erx using our pharmacy system, our claims are run through a multitude of edits to ensure that the information submitted on the claim meets Medicare guidelines. Additionally, the 270/271 eligibility access ensures that we are billing efficiently by requiring the correct patient information and only allowing claims through for beneficiaries who are covered on the date of service. Furthermore, Brookshire Brothers subscribes to erx Network s erx Recovery service which gives us an experienced representative who researches all of our denied claims and takes whatever action necessary (research, documentation gathering, appeals, redetermination, judicial reviews, etc. etc.) to ensure that we are paid on the highest number of claims possible. 21

22 Allwin Online Login Each store can log in to their own individual website by using their NCPDP as their username and their ZIP CODE as their password. They are all prompted to change their password upon initial login, hence, if they have been there before their password may be different. If any of them have login issues they can contact our support department at , option 1 DMEPOS Dispensing Incidents Brookshire Brothers must investigate any injury, incident, or infection in which DMEPOS may have contributed to an adverse event when Brookshire Brothers become aware. If a product may have contributed to a customer s hospitalization or death, we must initiate an investigation within 24 hours after becoming aware of the injury, incident, or infection. For other occurrences, we must open an investigation within 72 hours after being made aware of the incident. The investigation includes all necessary information, pertinent conclusions about what happened, and whether changes in systems or processes are needed. We must also consider the possible links between the items and the services provided and the adverse event. Pursuant to CMS regulations, you must fill out a REPORT OF DISPENSING INCIDENT form immediately. Follow the Dispensing Incident Procedures listed in the Quality Assurance (sec 8) of the Pharmacy Operations Manual. 22

23 Allwin Secondary Insurance We are in Region C and are a Non-Participating group. If a patient presents a secondary insurance card - do the following: 1. Look for the insurance company in the COBA (Coordination of Benefits Agreement)/Complimentary list: a. If the insurance company is on the COBA list, populate the Group Id with the Identification number listed (aka COBA). For example, AARP is i. The system returns a $0 Patient Pay Amount because the group indicates that the patient has a secondary insurance that will pay the 20%. ii. The claim goes to Medicare, and, based on the code entered, Medicare will forward the remaining 20% to the secondary insurance. iii. The secondary insurance company adjudicates 20% and sends payment to us. b. If the insurance company is not listed in the COBA/Complimentary List, it means that the secondary will not crossover from Medicare. We have two options: i. Bill the 80% to Medicare and collect 20% co-payment. The patient can keep their receipts and be responsible for billing the secondary themselves. ii. Find out if we are contracted with the secondary and try to COB their 20% co-pay. Do not paper bill. 23