RX TRAINING

Prescription Stage Training

How To Prep, Send, and Follow Up on Rx Requests!

Index

Following up on Rx Requests

Page 18

Intro to the Prescription Stage

Page 3-5

Prepping the Rx

Page 6-17

Reviewing Completed Documents

Page 19-22

Moving to Benefits

Page 23

Intro

Hover over the red bubbles for more information through out this training!

Introduction

• The Priscription stage involves preparing, faxing, and following up on the written order request we faxed to the doctors office for a signature.

• Once the doctor faxes us the completed written order along with other supplemental documents, it is then moved to the benefit reveiw/authorization stage to confirm insurance coverage.

Intro

Contents Of a Written Order Request

Below are the documents that make up a typical written order request

Intro

Some requests may also include additional paperwork that the physician needs to sign. This could include:

Specific insurance authorization forms:(For more complex deals/insurances)

Mount CMN form:For patients requesting a wheelchair mount

Prepping the Rx

Preparing and Sending the Written Order Request

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Generate the Prescription and cover letter

Combine the cover letter, Written order, ARPHI, and Evaluation in Adobe

Fill physician contact Properties

Fax the full request to the doctor

Step 1: Adding physician info to the contact page

• While on the patient's page, find the physician contact page under "Contacts" (Right column)

• Physician contact not listed? You can add a new or existing contact!

• Physician info should be located in the order form

• How to add a contact? Click here:

Prepping the Rx

Go to the properties section of the Physicians contact page and fill out the following properties:

• NPI Number (Located on the PECOS site)

• Pecos Enrolled? (Located on the PECOS site)

• Professional Letters (Located on the PECOS site)

• Fax# - (Located by calling the doctors office)

Prepping the Rx

Finding Physician info on the PECOS website

Link: https://opedge.com/Pecos/

Please note: A physician with a taxonomy of "Student" is not permitted to sign the Rx!

• Go to the Pecos website

• Enter physician first/last name and state

• Click Search

• Click the NPI that pops up
• Fill the physicians properties:

NPI, Pecos enrolled?, Prof letters

• Fill the deal/patient property "physician speciality" with the taxonomy

Video Recap: Adding Physician properties

Prepping the Rx

Calling the Doctors Office:

During the call:

• Ask for the fax number

• Confirm that the patient has been seen in the last 6 months (Provide their name and date of birth)

• Ask for the approxmiate turn around time for the request

Log the call:

• On the patients page click "Log call"

• Type #initialrxrequest - click enter

• Fill the call template during the call

• Add the fax# to the physician fax property

Prepping the Rx

Check for any additonal paperwork we may need to include in our request!

Check out these patient properties:

• Sale accessories Requested

If "mounting system" is listed, you will need to include the Mount CMN form that the SLP completed (see the docman)

• Other required paperwork

This might mention an evaluation signature, or additional form that needs a Dr signature.

• Auth Form URL

This would include additional insurance forms that may need to be signed by the physician If nothing above is mentioned, you only need to request the signed written order and medical records.

Prepping the Rx

2. Generate A Cover Letter & Written Order

We have added the physician information, and determined no other paperwork (aside from the written order & medical records) is needed. Lets now generate the Rx.

1. Go to the deal2. Click User tasks (Right column)3. Click Generate Prescription

Prepping the Rx

Generating A Cover Letter & Written order Continued

• Select the prescriber (physician)
• Fill in:

- Page number (Usually 9)- Todays date- Cover sheet comments (What you are requesting)

Cover Sheeet comment template: "Hello, my name is ____________ and I am a Clinical Documentation Specialist at Lingraphica, a DME provider. We have been recommended to provide a speech generating device for one of your patients. Please see the enclosed request for mutual patient of Doctor ______ with the following initials: __ Please fax: 1. Signed and Dated Written Order for Speech Generating Device 2. Last three (1-3) Office visit/Encounter/Progress Notes FAX TO: ____________, 609-275-1311"

Prepping the Rx

Next, confirm all of the info is filled and correct, then submit! You will find the generated cover letter and written order in the docman after a few minutes of processing

Prepping the Rx

sTEP 3: cOMBINING THE rX rEQUEST PACKET

• Open the following in Adobe:

1. Complete prescription (Cover letter & Written order)2. ARPHI3. Evaluation

• Click Combine Files

• Arrange the files in the order above

• Save the packet as "Patient Initials_RxRequest"

(Ex: AR_RxRequest)

• Upload the Rx request to the Docman

Prepping the Rx

Step 4: Fax the written order request

• Fax the request to the physician

• Log the fax (under logged calls) - Use snippit #fax

• Update Patient Property: Prescription status to "Active Request"

• Send an email update to the SLP using the template:

"CDS: Rx Request Sent"

• Set a follow up task for the next day to do a Rx follow up with the doctors office!

Rx follow ups

Following Up On The Written Order

Now that we faxed over the written order request:

• Call the office the next day to see if the fax was received.

- Log the call using snippit: #Rx Follow Up

• If not, verify that you have the correct fax, and re-fax the request
• Try to follow up every day until they confirm the request has made it to their office for processing.
• Once they confirm they have the request, set a task to follow up in the next 2-3 buisness days to check in on the status of the request.
• After 2-3 weeks of waiting for the completed the request, reach out to the SLP and/or caregiver to see if they can give the office a call regarding the request! That often helps with getting a quicker response.

Click the audio button to hear an example of an Rx follow up call!

Reviewing Paperwork From The Doctors Office:

You have received a fax from the doctors office! Lets make sure everything meets insurance requirements.

To move forward you need:

• The signed and dated Rx

- Must be signed and dated by the listed physician

• The medicals records

- Should be within 6 months old, and make mention of the primary diagnosis, and a speech impairment.

• Any other requested documents

- If a mount form, or authorization form was also included in your request.

The Signed Written Order What to look out for

• Doctor's name and professional letters should always be listed along with the correct NPI number

• The signature must match the listed physician

• The signature date must be listed

• The date should always be on or after the date of the signed SLP evaluation.

• Double check that the diagnosis on the Rx match the SLP evaluation!

Examples Of Signed Rx's That Are NOT Insurance Compliant

Fax a revision request to the doctors office.

The signing physician did not cross out the name and NPI of the listed physician.

Missing the signature Date.

Physicians professional letters are missing.

Reviewing the Medical Records:

Take a look at the patients diagnosis:

For this example: CVA (Stroke) and Aphasia

Medical records should:

• Mention the patients Primary diagnosis

For I63.9 Cerebral Infarction, any mention of the following would suffice: Stroke, CVA, Cerebral hemmorage, cerebrovascular accident.

• Mention a speech impairment

Words like: Non-verbal, speech difficulty, aphasia, dysphasia, speech therapy, etc are all sufficient.

• Dated within the last six months

There can be some wiggle room with the 6 month rule, When in doubt, check in with your team!

Moving to Benefit Review

Once you have determined that the Rx and medical records meet all of the requirements we can move the deal to the benefit review stage! To do this:

• Use the playbook: "CDS- 8. RX/MR Received (F2F Compliance Complete)"

- Find playbooks in the right column of the deal

• Fill out the playbook with the requested info

- This includes Rx Signature date, when it was received, date of the visit note, the mentioned diagnosis & speech impairment, any other received paperwork, etc."

• At the end of the playbook, update the prescription status to "Benefit Review". This will automatically task the benefit reviewer to follow up.

Success!

You have completed the prescription stage! No follow up task is needed. Once Benefits and Authorization (if needed) has confirmed coverage, they will move it along to the confirmation stage where you will be tasked! One stage away from making your first sale!

Create A Contact For The Physician

2. Check to see if they have an existing contact page

3. Create new contact if they do not have an existing page

1. Add the physician as a contact in the deal