SaintAlien
Member
- Joined
- Mar 3, 2016
- Messages
- 380
I thought I'd start a topic for those with some common questions about records, pharmacies and why denials happen. I can answer just about anything you'd want to know in regards to how the system works in both hospital, urgent care settings and some private practice. My expertise is in emergency/ urgent facilities the last 3 years and not private practice. Keep in mind that private practices ARE in networks with hospitals (Companies).
To answer the most basic of question & information everyone on here should know: Most medical practices use the same EMR software (EPIC) to look at medical records. This means that typically all hospitals and some urgent cares are connected through this. Now, if it's a situation where we need to call in a scheduled/ black box substance, we can see if you recently had a similar or same script called in to a pharmacy (any pharmacy, regardless of the one you give us). We definitely won't give you too much grief if say you were written a medication that was for 5 days only *example* and you visit us on day 6; although we will ask about if you had recently seen anyone, gotten a similar script etc. If we have to ask because it wasn't disclosed "Did you have. a recent Dr's visit to receive this Rx?", most often you will be denied as it can be viewed as "Dr shopping". It's the prescribing attending's discretion some might choose to fill it but I advise to be apologetic (not overtly so), so you're not flagged as seeking. The best is just to say it up front and state a situation with your primary care (can't get in, don't have one) had to go to XYZ to get this med filled because of xyz symptoms and it's not resolved. Not all urgent care facilities use this software and most do use paper scripts for anything controlled, but if they call it into a pharmacy or a complimentary med to go with the paper script - it will be flagged and the questions will come up. Almost all Emergency rooms do use this software.
I hope this gives a basic "how did they know?", guide. I'm here to answer any questions that you feel comfortable with asking and I feel anonymous answering.
To answer the most basic of question & information everyone on here should know: Most medical practices use the same EMR software (EPIC) to look at medical records. This means that typically all hospitals and some urgent cares are connected through this. Now, if it's a situation where we need to call in a scheduled/ black box substance, we can see if you recently had a similar or same script called in to a pharmacy (any pharmacy, regardless of the one you give us). We definitely won't give you too much grief if say you were written a medication that was for 5 days only *example* and you visit us on day 6; although we will ask about if you had recently seen anyone, gotten a similar script etc. If we have to ask because it wasn't disclosed "Did you have. a recent Dr's visit to receive this Rx?", most often you will be denied as it can be viewed as "Dr shopping". It's the prescribing attending's discretion some might choose to fill it but I advise to be apologetic (not overtly so), so you're not flagged as seeking. The best is just to say it up front and state a situation with your primary care (can't get in, don't have one) had to go to XYZ to get this med filled because of xyz symptoms and it's not resolved. Not all urgent care facilities use this software and most do use paper scripts for anything controlled, but if they call it into a pharmacy or a complimentary med to go with the paper script - it will be flagged and the questions will come up. Almost all Emergency rooms do use this software.
I hope this gives a basic "how did they know?", guide. I'm here to answer any questions that you feel comfortable with asking and I feel anonymous answering.
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BTC seems to be climbing as well and your prediction of $120k seems spot on