Showing posts with label Medical prescription. Show all posts
Showing posts with label Medical prescription. Show all posts

Monday, September 15, 2014

Managing Electronic Prescriptions



English: Novamoxin Prescription Drug - Amoxici...
English: Novamoxin Prescription Drug - Amoxicillin Trihydrate (H-6) 500 mg Français : comprimés de trihydrate d'amoxicilline 500 mg (Photo credit: Wikipedia)
Pharmacy Rx symbol
Pharmacy Rx symbol (Photo credit: Wikipedia)
These days with the advent of electronic prescriptions,the medical assistant will they are increasingly responsible for dealing with complex prescriptions issues . The dawn of the electronic prescription means more and more of the medical assistant's time will be consumed with prescription related tasks.
This will not only mean submitting prescriptions, but dealing with the problems most medical assistant did not have to deal with, in the good old days of paper prescriptions. Pharmacies will be sending back to your email all sorts of requests. Insurance companies will also send a record number of requests and even alternative prescription suggestions.
Patient's complain to you the drug is not covered.Then you will have to spend endless hours finding out what is on the patient's formulary that is covered. If the doctor is unwilling to allow the change, then you must call the patient. The patient will ask you which pharmacy near their house, charges less for the drug. The patient will expect you to check the discounted drug list of every big box store and grocery in the area to find out who will charge them the least amount of money for their prescription. If you office does not have good prescription management polices; then the wonder of electronic prescriptions will become your nightmare.
As a medical assistant doing a specialty clinical, I saw the process of taking hours to get one prescription filled or renewed ;endlessly repeat itself. This left medical assistance's behind on other duties and patient's frustrated and angry. You are-now responsible for patient drug education of a new kind This is not the kind the pharmacist gives, your patients on drug interactions.This is the kind that tells the patient how they need to take some personal responsibility for this new way of doing prescriptions via the internet.

Many patients simply will not fill prescriptions not covered by their insurance. They put themselves at risk and are inclined to take the problem out on the doctor.They do not understand that they can not wait two weeks to pick up a prescription that has been electronically sent. Many wonder why the prescriptions were not just waiting for them when they show up at the pharmacy two weeks are the prescription was sent by the doctor's office .The patient's are upset that they had to wait at the pharmacy for the prescriptions to be refilled a second time. Patient's need to understand once a prescription shows up electronically at the pharmacy that it will be filled within hours; not days or weeks.
There are many different pharmacies today with large amounts of low cost drugs available for under ten dollars. Yet, the patient whose insurance company will not cover his or her drug; is never at the pharmacy where that prescription is on the five dollar list. They call you to find out where they need to go.

Just A Plan Full of Good Policy Will Make the Medicine Go Down In A Less Stressful Way

So what is the solution? It is a well thought out office policy for dealing patient education and processing of prescription drugs. Below is my attempt at the task. My hypothetical policy will not apply to all types of practices . Most of these rewrites of current office policy should be a shared task among office staff that deal with patient prescriptions .
This office will accept prescription renewals from pharmacies via fax and phone from local pharmacies.
No prescriptions ;which are considered controlled substances or for short term drug therapy will be renewed other than by the patient coming in for an in person visit with the doctor or nurse practitioner.
This office will establish a rotating schedule of Medical Assistants to handle prescription renewals via fax or phone.
There will be a designated phone line that goes to voice mail where patients can call in prescriptions they wish to have called into a local pharmacy.
Patients will be informed on this line that all prescriptions should be called in to the local pharmacy within twenty four hours. If they call on a holiday or weekend the prescription would be called in within 24 hours of the next business day.
Patients must leave the generic or trade name of the drug, the amount taken, doctor's name, and amount of refills on the prescription on the answering machine Patients with incomplete information will not have prescriptions called in. Instead, these patients will be contacted by staff , to get the right information about the prescription.
Every working day the staff in charge of the prescription line will transcribe the recordings They should pull the charts i of the patients requesting refills. It is wise to check to see if your doctor was the original prescribed. It is really not unusual for primary care physicians to write prescriptions originally given by specialist. The doctor may need to review the chart if this situation occurs.. Some doctors will not do this ;unless the patient schedules an appointment to ask the doctor to take over their prescriptions for chronic conditions.
The Medical Assistant will fill out a patient prescription renewal form for each patient.
This form will be returned to the MA ,after physician reviews it. those drugs approved for renewal will be called into the local pharmacy by the medical assistant . This should occur within 24 hours . In cases in which the doctor wishes to review the prescription or change it , MA will call the patient and advise them or the change or review.
Patients who call for drug formularies to be reviewed because a drug is no longer covered ;need to make an in person appointment with the Medical Office Assistant to review their coverage. They must provide new copies of the formulary of covered drugs. Once a list of new covered drugs is complied it will be given to the doctor for review and an appropriate covered drug will be called in. There should be a least a week allotted for this process.
In general generic drugs will be prescribed unless not permitted by the prescribing doctor.
Patients are expected to report problems with prescriptions in a timely manner so the prescription can be changed in a reasonable amount of time.
One parent of minor patients should be in charge of renewing and monitoring their child's prescriptions. The designated parent should be noted in the chart.
In the case of elderly or disabled patients 'who do not handle their own medical affair,s should have a designated contact person for prescription related issues noted in their chart.
All patients in this practice who take prescriptions for chronic conditions will have a yearly prescription review by the doctor or nurse. They need to keep this appointment to be eligible for prescription renewal by phone or fax after the initial twelve month period.

Patient Education :

All medical assistants are expected to have a base knowledge of drugs frequently prescribed in this practice and their potential hazard of use.
The practice will have consumer drug information sheets containing basic information about common drugs or classes of drugs prescribed in this practice.
Medical Assistants will discuss with patient's information about new prescriptions.
Medical Assistants will emphasize drug interactions with herbal or over the counter drugs regardless of if the patient admits using them.
Medical Assistant will emphasize the need for medication compliance. They will discuss issues that might cause patient non compliance.
Medical Assistant can demonstrate inhalers and the use of insulin pins if the patient or their care taker requires such instruction.
Patients will be advised to report good changes and bad changes in their condition once they have started a prescription drug. They should always call the office with drug concerns.
Patients should be encouraged to read prescription inserts and ask their pharmacist questions about their medication.
Patients are to be instructed to call the office before adding other prescriptions or OTC to their drug routine. Patients not complying with this policy may lose their right to have prescriptions renewed by phone or fax.

Tuesday, August 5, 2014

Dealing With Difficult Patients

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Patient Toilet
Patient Toilet (Photo credit: ConanTheLibrarian)
lightning UX 7
lightning UX 7 (Photo credit: tim caynes)
Vaccination Every Morning
Vaccination Every Morning (Photo credit: madam3181)

English: Night at the Doctors office
English: Night at the Doctors office (Photo credit: Wikipedia)
Patient: Doctor, I don't feel well and I'm not...
Patient: Doctor, I don't feel well and I'm not sure why (Photo credit: DES Daughter)
A patient having his blood pressure taken by a...
A patient having his blood pressure taken by a physician. (Photo credit: Wikipedia)

Dealing with difficult patients is something that when we train to be medical assistants gets over looked. We have course in professionalism which many assume eliminate the problem. We are not always the source of anger or misunderstanding that our patients display. If is wise to have an office policy in place that gets everyone on the same page when it comes to our approach to deal with difficult patients. I would divide most difficult patients into two groups; front office and exam room. Here I will deal with the difficult patient in the front office.

 The front office difficult patient is one who is often upset with staff about scheduling, billing, and prescription refill issues. Many times these are patients who do not understand that their insurance does not give them a totally free ride when it comes to care. When they get the bill for their portion of care they are usually convinced the office billed their insurance wrong. Sometimes they suffer from sticker shock when they see the amount of their co pay that has accumulated when they have had a condition that required numerous office visits. The patient who is suffering from medical bill sticker shock can be dealt with. First it helps to have someone doing the billing in the office that is willing to talk to patients about their financial responsibility. If a patient has a forty dollar co pay for an office visit and their treatment is going to require several follow up visits they need to be informed. It is simply best practice to collect the co pay upfront so the bill does not become exorbitant in the first place. New patients should not just be handed an office payment policy.

 They should be verbally informed that payment is expected at the time of service for their co payment. If patient’s have questions about how much of their treatment is covered by insurance, someone in the office should be willing to help them find out. Since we do not have crystal balls and can not predict how well treatment will go, we need to emphasize that it is only an estimate. Ultimately, it is the patient’s duty to deal with their financial obligations to the practice. Most patients new or established will not admit when they are in financial difficulty. They wish to keep such matters private until they are unable to pay their bills.

 Again, if your office offers financial arrangements for patients who are going to have default paying their share of the bill they should know about this policy before they need it. Discussion of a patient’s financial hardship should take place in a private setting and only staff that does the billing needs to be aware of their circumstance. The financial health of a patient should be guarded information just as their medical information is. The patient that is upset about scheduling is many times an established patient.
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They may have been in the practice when it was relatively new or had more staff. They became used to being able to have a wide variety of choices when it to seeing the doctor or nurse fractioned. They also may feel entitled to see the doctor when they want because they have been loyal to the practice. This patient needs to be told that all patients are accommodated the best way possible when they call for an appointment.

They also may need to be reminded that those with serious conditions are seen sooner then those patients who are being seen for routine matters. It helps to thank these patient’s for their patience and offer to really work to schedule them at the next most convent time for them. You will not always win this battle as some people because of social position are catered to by their hair dressers, mechanics, and other service professionals.


They simply will not understand that the doctor’s office is not in the business of catering to the busy professional schedule. In this case you may recommend a walk-in or urgent care clinic in case this patient’s will not give up their insistence on being seen immediately. This action should not be taken with out consulting the health fractioned first. You also may have the option of offering these patients the opportunity to see another doctor in the practice with a more open schedule. Patient’s that are upset about prescription issues again should receive a copy of the office policy in regard to refills.

 If they call a dedicated line for refills they need to know that you will take at least one business day to respond. If they insist on refills on a medication that has expired, they need to understand they may need to come in and see the doctor in order to have the prescription renewed. You have to stand strong on your practices policy. This is especially true in regard to controlled substances. Many states have strict regulations that must be followed when dealing with the class of drugs.

Lastly, electronic prescriptions and changes in drug formularies are issues you have little control over. You should always advise a patient to wait 24 hrs and call the pharmacy to see if an electronic prescription has been filled. You should encourage patients to put long term prescriptions on automatic refill. You can call on patient’s behalf if they have issues getting their electronic prescriptions filled, but as long as you have done it right on your end there is little you can do about the speed at which the pharmacy on the other end. Most doctors will change a prescription to something covered by the patient’s insurance, but it is the patient or their care takers job to find out what prescriptions are covered and which are not. Sometimes for medical reasons an doctor will petition the insurance company to cover a certain drug, but this is a cumbersome process and can not be done for every patient.Communication is the best way to avoid angry or frustrated patients in the front office
. You should always be respectful and honest about the things you can and can not help the patient with. Most people will calm down and do their part to solve the problem if you are clear on what you can do to help them deal with their particular issue.