 | Peter Sayers |
Peter Sayers is vitally concerned about pharmacy professional practice - its innovation, its research and development, and its delivery to create an ongoing revenue stream. Delivery of healthcare is increasingly involved with Information Technology systems. All perspectives in IT must be considered for the impact on pharmacy practice and its viability. | |
Well, we are past July 1 and there has been no official statement on how, when and where the 15 cent payment for electronic prescriptions materialises.
Government does not appear to have specified how it wants a pharmacy claim presented, and system vendors may not have included a module to create an acceptable audit trail as yet.
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One aspect the government is certain about and that is there is no payment for a manually loaded script entered into a system like eRx, and that electronic scripts for payment must have originated from a GP software system and been uploaded electronically.
For the moment, the majority of scripts entered manually into the eRx system cannot be distinguished from those uploaded by GP systems. Even with the best of goodwill pharmacists will not be able to separate the two forms of prescriptions once lodged with an electronic hub such as eRx.
What to do?
Pharmacies must either claim all prescriptions are electronic and claim for everything or alternatively, claim for none given that they will be unable to prove the origin of a script once it is entered within the system.
The other alternative is to find a vendor that can deliver an appropriate audit trail and verification system.
But will the majority of GP’s your patients deal with be registered on that system if indeed one exists at the moment?
While an electronic prescription definition exists within the Fifth Community Pharmacy Agreement, its definition is too loose.
If pharmacists claimed for all the scripts they normally entered into their PBS general claim how can government currently disprove this?
One government spokesman is quoted as saying “Medicare will be watching and auditing for inappropriate behaviour by pharmacists.”
But how will government define and actually prove inappropriate behaviour is contained in a claim for the 15 cent payment per script?
They have no way of knowing where the script came from.
And neither does the claiming pharmacist!
When this was pointed out to the government spokesman he responded “he hoped that pharmacists would do the right thing”, otherwise “the practice of manually uploading and then claiming after downloading was a problem which would need to be addressed else it could 'inadvertently' lead to fraudulent claims.”
With this level of decision-making it is little wonder government has wasted so much money on e.health and that bewildered vendors spend countless hours on providing solutions (at their own cost) trying to fill government gaps.
Meanwhile, coalface pharmacies could be waiting forever for payment given the apparent indifference by government in providing a solution.
There can only really be one fair decision – government should pay 15 cents on all PBS prescriptions immediately until they can properly specify a solution for vendors to follow and implement.
Don't hold your breath.