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Pre-QA
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Created on August 27, 2024
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Transcript
Pre-QA
ScriptMed: Pre-QA
Start
Setting up prescriptions and soft stop Rx clarifications.
1) Introduction
2) Modules
3) Activities
4) Quiz
Pre-QA
Main Menu
Introduction
PCC
Intake Prep
Pre-QA
Image Intake
What is Pre-QA?
ScriptMed operates in stages. Each stage is a piece of the puzzle that moves an order closer to shipping out and helping a patient Get Better!Pre-QA is the second stage in the new patient/therapy workflow. This stage is where the prescriptions are set up for the patient. In this course you will learn how to set up medications, supplies, clarify a prescription, and set up a line to fax the provider. Click the arrow at the right to begin!
Image Intake
Pre-QA
The Basics
- Pre-QA is the data entry stage for a prescription or nonprescription.
- Prescriptions include anything sent by the provider including: medications and supplies that will be billed to the insurance
- Nonprescriptions include anything that will not be billed to the patient's insurance including: courtesy supplies, cash price medications, and fees
- Rx clarifications may be required in this stage if the prescription is unclear
Pre-QA is dependent on receiving a new referral for a patient (whether new or existing) in the Image Intake stage. The referral will be set up with all medications and supplies based on the prescription received!
The Number in the tile tells how many patients there are in Pre-QA to be worked.Unassigned means that is how many patients have not been assigned to a team member & need to be completed.
Tile Definitions
How to find the Pre-QA Stage Tile
Navigation
The Pre-QA stage tile is located on the My Dashboard screen and is only available to team members with the authority to set up prescriptions and supplies!
- Clicking Search will pull up all patients in the Pre-QA stage
- Clicking Next will automatically open the oldest patient in the queue
- Clicking Assign will open the oldest patient that is assigned to you in the queue
04Outbound Request Lines
How to set up a fax request to the provider
Training Modules
Learn all there is to know about the Pre-QA stage.
01 Setting up Rx Lines
How to set up prescribed medications and supplies
02 Non Rx Lines
How to set up non-prescribed (cash price or courtesy) medications, supplies, and fees
03 Rx Clarifications
Correcting or escalating a prescription that requires further explanation.
01
Setting Up Rx Lines
How to set up prescribed medications and supplies.
01
Accuracy is key!
Rx lines include the medication or supply that we will dispense based on the prescription sent by the provider. These lines will be set up in the Manage Lines chevron of ScriptMed. It is crucial to pay close attention to the prescription when setting up medications to minimize errors, ensure a positive treatment outcome for the patient, and reduce adverse drug interactions. A pharmacist will review the prescription in the Order module, but this is AFTER the patient schedules their medication.
To start adding a prescription to the patient's profile, click +Add Rx Line.
Manage Lines Chevron
The Manage Lines Chevron will automatically display when a patient is opened in Pre-QA. It will show the referral documents that were tagged as Prescription from the Image Intake stage.
All prescribers matching the search criteria will appear along with all of their locations - if there are multiple! Select the correct prescriber and location by clicking the location hyperlink on the presciber's card.
Adding the Prescriber
The first step in setting up an Rx Line is adding the prescriber! Review the script and search the prescriber by NPI, first name, or last name!
Once the item is selected, it will appear in purple letters. Now it is time to complete the set up!
Adding the Medication/Supply
After the prescriber has been added, the medication or supply now needs to be located and added! In the Item Name field, enter the first few letters of the item name and click Search.
Required Fields
Click the image to expand
Line Details
DAW: dispense as written or are substitutions allowedQuantity: quantity for the current fill. Use vials for a medication.Refills: number of refills prescribedDays Supply: number of days the item prescribed is intended to lastDate Written: date the prescription was writtenExpiration Date: automatically populates based on Date Written enteredOrigin: where Rx originatedTreat as Supply: Rx Line defaults to no. Non Rx Line defaults to Yes. Can be modified as needed!Dose Amount: quantity for one doseDose UOM: use ML for medicationDose Frequency: how often the patient takes one doseDose Type: use Maintenance DoseWritten Information: automatically populates based on previously entered fields (Quantity, Refills). Total Quantity=Quantity Written*Refill Quantity.SIG: instructions to be included on the prescription label. There are Sig shortcuts for different medications and needs.Click the interactive icon for the Sig Codes Guide!
Once all Lines are added, go to the Review & Complete Chevron and Complete the patient out of the Pre-QA stage!
Complete!
Click Ok once you are finished adding that Rx Line. If more prescriptions need to be added, click Ok & Add Next Line, then repeat the Adding Rx Line process. If non-prescription items need to be added, click Ok then follow the process for Adding Non Rx Lines.
02
Non Rx Lines
How to set up non-prescribed (cash price or courtesy) medications, supplies, and fees
See the next page for differences between the two processes!
The steps we reviewed in the Adding Rx Lines Module is the same process for Adding Non Rx Lines:
- Adding a prescriber
- Searching the medication/supply/fee
- Completing required fields
- Save & Complete
02
Similar, but different
There are many similarities between adding Rx Lines and adding Non-Rx Lines. However, Non-Rx Lines will not bill the medication or supply to the patient's insurance. DirectRx will cover the cost of courtesy shipments, and patients will cover the cost of cash price shipments and fees. Non-Rx Lines can include cash price supplies, cash price medications, and fees.
Billed to DirectRx or patient
Billed to patient's insurance
Medications/Supplies/Fees
Treat as Supply is automated to Yes
Dose amount & Sig are not required
DirectRx Pharmacy is the prescriber
Patient's healthcare provider is the prescriber
Treat as Supply is automated to No
Medications/Supplies ONLY
Dose amount & Sig are required
Non Rx Lines
Rx Lines
Required Fields:QuantityRefills Days Supply Origin Written Qty Can be: Medications/ Supplies
02
Rx vs. Non Rx Lines Faxes
Although Rx and Non Rx Lines follow the same process for being added to a patient's profile, there are key differences when setting them up.
03
Rx Clarifications
Correcting or escalating a prescription that requires further explanation
03
What is an Rx Clarification?
Rx Clarification: prescription (either new or refill) requires further explanation or clarity to make the script valid due to system or prescriber errorsScript items that may need clarification:
- Patient Demographics (Name, DOB)
- Provider Demographics (Name, NPI, Address)
- Drug Name
- Drug Strength
- Drug Directions
- Quantity to be dispensed with proper Unit of Measure (UOM)
- Prescription signed and dated by prescriber
Click the image to expand
Hard & Soft Stops
- There are some types of Rx Clarifications that we can adjust the script to complete setting it up- these are called Soft Stops because you have to pause and complete an additional step during Rx Set Up
- There are other types of Rx Clarifications that require additional documentation from the prescriber -- these are called Hard Stops because you cannot move forward with Rx Ste Up.
Missing Directions
How to handle prescriptions missing directions
Click the (+) below each section before moving on.
Albuterol PRN
Medicare guidelines for patients with aformoterol/formoterol and albuterol
Handling Different Kinds of Soft Stop Clarifications
Patient/Provider Demographics
How to handle this type of missing information
Missing Rx Date
How to handle prescriptions missing a date
Quantity of Sodium Chloride
How to handle sodium chloride quantity sufficient
Incorrect Unit of Measure
How to handle a conflicting UoM
Start by popping the image out to a new window by clicking this button
When a soft stop clarification is identified, you may need to annotate the image to proceed.
Outline
Click this icon to create an outline around a specific part of the image.
Annotating Images
Add Text
Click this icon to add text to an image.
Highlight
Click this icon to highlight a specific part of the image.
Make Notes
Click this icon to create a sticky note on the image.
Don't forget to save your annotations!
Quantity Does Not Match Directions
If the quantity and the directions do not match (ex. script is written for budesonide 1mg/2ml, but directions state to take 1ml BID), we cannot proceed with rx set up. Escalate to PCB for a pharmacist or licensed pharmacy technician to complete the rx hard stop clarification process or take a verbal order.
Missing Provider Signature
The prescription is not valid unless there is a signature from the provider. Escalate to PCB! Pharmacists or licensed pharmacy technicians can call to get a verbal order or complete the Rx hard stop clarification process.
Missing Quantity
We cannot fill a prescription without a quantity. Escalate to PCB for a pharmacist or licensed pharmacy technician to complete the rx hard stop clarification process or take a verbal order.
Handling Hard Stop Clarifications
Stop! Do NOT proceed with setting up the prescription.
When you see any of the following hard stop clarifications, create an outbound request line, and send the patient profile to the Pharmacist Call Back (PCB) stage.
04
Outbound Request Lines
Setting up a fax request to the provider
When a hard stop clarification is identified, create an Outbound Request Line to streamline the PCB process!
Creating an Outbound Request Line
1.
Add Outbound Request Line
Select the +Add Outbound Request Line to start! Once that is selected, search and add the prescriber from the prescription!
2.
Add the item
Just like adding an Rx or Non Rx Line, you have to add the item that needs the clarification for the Outbound Request Line
3.
Ok, Save & Next
All done!It's very important to check your work for accuracy before you complete the patient profile and send it on to the next stage.
Show what you know!
Activities
Lists
Choose the correct answers for each identified category.
Identify
In each image, click in the correct place based on the scenario. Be prepared, it is timed!
Identify
Click on the correct items that fall under each category (Rx Lines vs Non Rx Lines)
Rx Lines
Dose Amount Required
Treat as Supply = Yes
Fees
Medications/Supplies
Qty not Required
Billed to Insurance
Prescriber = Provider
SIG not Required
Non Rx Lines
Prescriber = Provider
SIG Required
Dose Amount Not Required
Fees
Prescriber = DirectRx
Cash Price/Courtesy
Solution
Qty not Required
Billed to Patient or DirectRx
In order to start setting up a supply with a prescription, you must click Add Rx Line.Clicking Add Non Rx Line will start setting up a non prescribed supply/medication. Clicking Add Outbound Request Line will start setting up a fax request to the provider.
00:15
Identify
Click where you would in the Manage Lines chevron to begin setting up a prescribed nebulizer for a patient.
Identify
You start to add the prescriber to the patient's prescription, but see the prescriber has mutliple locations! After review the prescription you see this location is on Kirts Blvd. Where do you click to add this prescriber to the Rx Line?
00:20
In order to proceed with adding this prescription, it is essential that you click on the location of the provider's office at DirectRx Pharmacy. This step is crucial for ensuring that the prescription is properly associated with the correct provider.
Always check the Medical Profile documents to see if additional information on the prescriber can be found from any document the office sent! If not, check the NPI Registry at https://npiregistry.cms.hhs.gov/search and use a search engine to find the office's information.
00:20
Identify
When reviewing a prescription you notice it is missing some prescriber demographics (NPI and fax #). Click on where you would first look to find that information.
Assessment
In this section, you will test your acquired knowledge throughout the course. Our interactive quiz will provide a detailed assessment of your understanding of key topics. Get ready to challenge your skills and reinforce your learning as you move towards mastering the fundamental concepts.
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PCC
Intake Prep
Pre-QA
Image Intake
Home
Course completed!
Sodium Chloride Qty Sufficient for 30 Days
In the example, the provider checked the "Qty Sufficient for 30 Days" box, and the directions are for the patient to take 1 vial three times dialy, so we know to dispense 60 vials to be sufficient for 20 days. Rule: If the directions are 1 vial BID (twice daily), we would dispense 60 vials which is quantity sufficient for 30 days. If directions read TID (3 times daily), we would dispense 60 vials to be sufficient for 20 days
The Highlighter Icon allows you to highlight a specific part of the image by clicking over where you want the highlight to appear. You can always move the highlight around to where makes the most sense for the clarification on the script.See the example above!
Multiple Items Match
If you type in a medication or supply name that matches mutliple results, they will display in a pop-up window. Select the medication hyperlink of the correct dosage and amount of the medication !
Example: Medicare Part B primary patient was written a Rx for albuterol with PRN directions Action: DirectRx can dispense less than the quantity written if it makes sense with the directions
Albuterol PRN
In this example, the Rx is missing directions for formoterolSolution: review clinical notes for directions and proceed If not, send to PCB for a pharmacist/licensed pharmacy technician
The Notes Icon allows you to create a sticky note on the image by clicking on the image and dragging down. You can move the note around to where makes the most sense for the clarification on the script.See the test example above!
Search for the prescriber and add them like you normally would!
Step 1
Select Add Outbound Request Line from the Manage Lines chevron.
Billed to Patient or DirectRx
Cash Price/Courtesy
Prescriber = DirectRx
Fees
Dose Amount Not Required
Prescriber = Provider
Billed to Insurance
Medications/Supplies
Dose Amount Required
Close
The Text Icon allows you to add a text box by clicking on the image and dragging down. You can move the text around to where makes the most sense for the clarification on the script.See the test example to the right!
In this example, the Rx is signed by the provider, but is missing all provider information. Look through other documents or the NPI Registry!
In this example, the patient's date of birth is missing. Look through the patient's medical profile documents for the DoB!
Missing Patient/Provider Demographics
How to handle missing demographic information on a prescription:
- Review the documentation we have or the NPI Registry
- Add the missing information to the prescription by annotating the image
In this example, the Rx has a Quantity on Rx written as 30 mL (10-day supply). It should be either be 30 Vials or 90 mL based on directions Solution: review clinical notes and correct UoM on the Rx and proceed If there is no correct UoM on the clinicals, send to PCB for a pharmacist/licensed pharmacy technician to take a verbal order
Incorrect Unit of Measure
Once added, complete the Quantity, Refills, Days Supply, Date Written, and SIG that is on the current Rx!
Step 2
Adding the Item
Search for the item like you would when adding an Rx or Non Rx Line!
Before you click Save & Next Activity to complete the patient out of Pre-QA and into Pharmacist Call Back, make sure to double check that the outbound request is line is set up correctly. Once complete, click Save & Next Activity and go to the Review & Complete chevron. Pend the patient. Select the follow up date of today, Outcome Status of Send to PCB, and Outcome Sub Status of Rx Clarification. Once the proper statuses are selected, click Ok. That patient will move to PCB for a pharmacist or licensed pharmacy technician to work on the next steps!
Save & Next Activity
In this example, this referral form is signed and completed by the provider, but is missing a date. To solve, add the fax transmission date or the date the Rx was received to the fax image and continue!
The Outline Icon allows you to create a rectangle outline around a specific portion of the image by clicking on the image and dragging where you want the outline to appear. You can move the text around to where makes the most sense for the clarification on the script. See the test example to the left!