Monday, November 28th, 2011
This year, the Centers for Medicare and Medicaid Services released its 2012 Final Rule regarding prescriber identification number validation on Medicare Part D drug claims. In it, the CMS raises concerns regarding the large number of invalid prescriber identification numbers and the possibility of prescription fraud and drug abuse.
In response, the CMS is now requiring Medicaid Part D sponsors to confirm the validity of Drug Enforcement Administration numbers on drugs listed in schedules II through V or map National Provider Identifier numbers to the prescriber’s DEA number. It also requires that sponsors confirm that the controlled substance is within the prescriber’s scope of practice to prescribe and that all identifiers are valid and active.
While the Final Rule allows for pharmacies to create their own verification system using DEA registrant files, the Social Security Administration death file, OIG and Medicaid program excluded provider lists, and the CMS National Plan & Provider Enumeration System database, it also allows for the contracting of third-party vendors to supply prescriber information and facilitate the validation process.
While the choice is left up to pharmacies as to how they meet these requirements, for many larger pharmacies, contracting with a third-party vendor will make the most sense as the number of claims these large pharmacies process coupled with the numerous databases that must be checked and maintained make creating an internal system of DEA and NPI validation inconvenient and cumbersome.
Pharmacies looking for a third-party validation partner to provide up-to-date prescriber data have been choosing Healthcare Data Solutions’ prescriber validation services. HDS’ comprehensive prescriber validation databases update DEA and NPI numbers to provide the most current and accurate prescriber validation information available, assuring pharmacies a dependable partner in Medicare Part D claims compliance.
Contact Healthcare Data Solutions today to learn more about how HDS products and services can assist with Part D compliance.
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Category Federal Health Regulation, Healthcare News, Medical Billing | Tags: Tags: CMS Compliance, CMS ruling, Healthcare Data Solutions, Medicare Part D, Pharma, Prescriber Validation, Prescriber Verification, prescribers,
Wednesday, August 24th, 2011
If your state doesn’t yet have a prescription drug monitoring program in place, it will soon. With most states, as well as Washington D.C., implementing PDMPs, and legal precedents leaning toward expanded liability on the part of the pharmacist, those looking to stay ahead of the regulatory curve are turning to prescription validation databases to build their in-house PDMP system.
A recent article in industry news outlet Drug Topics outlines some of the legal precedents that are shaping the discourse on PDMPs. Author Kathryn Foxhall notes that with the tide of legal arguments moving towards an increase in liability on the part of the pharmacist in drug interaction cases, most states will eventually move towards drafting laws that use prescription monitoring programs to curb fraudulently obtained prescriptions and doctor shopping, and that pharmacists will likely have a legal obligation to administer those programs.
In addition, with the development of a national prescription medication program complete, many states are choosing to stay ahead of an impending federal mandate by voluntarily going online with the national program.
Independent and chain pharmacies in states without a current PDMP would be wise to follow the lead of those states voluntarily participating in the federal program by making procedural and structural changes to prepare for the impending institution of prescription drug medication monitoring programs.
As public and legislative eyes turn more toward the problem of opioid addiction and prescription drug abuse, it’s only a matter of time until every state is required – either by state or federal legislation – to participate in prescription medication programs. According to the latest information provided by the DEA’s Office of Diversion Control, 35 states have fully operational prescription drug monitoring programs, 14 (including the District of Columbia) are partially operational and 2 have pending legislation. Forward-thinking pharmacies that begin planning for this impending legislation will be better suited to minimize the disruption of regular business as well as the cost of changeover.
Pharmacies can look to Healthcare Data Solutions to find the accurate prescriber data that is essential to creating an effective prescriber validation database and will ultimately be instrumental in complying with prescription drug monitoring programs that are on the horizon. Healthcare Data Solutions’ comprehensive and up-to-date prescriber validation databases are cleansed and updated weekly to provide the most accurate prescriber validation information available, assuring pharmacies a solid foundation of data on which to build their validation program.
Contact Healthcare Data Solutions today to learn more about how HDS products and services can assist with your state’s current or impending prescription drug monitoring program.
