Karthik Yamjala | HU ID: 113856
Harrisburg University
ISEM 525
Professor Shane Tomblin
Exercises 1.6 and 1.7 from Dumas
Exercise 1.6
1. What type of process is the above one: order-to-cash, procure-to-pay or issue-toresolution?
This process is order-to-cash
2. Who are the actors in this process?
The actors include the pharmacists, the pharmacy technicians, the insurance representatives, the doctors (if necessary), and the patient for whom the prescription belongs to
3. What value does the process deliver to its customer(s)?
The customer may retrieve their prescriptions in a timely manner that allows for them to quickly receive their order around a schedule that works for them. It also allows them to seamlessly receive their prescriptions by leaving the negotiation up to the doctor, insurance, and the pharmacist to ensure that all the needs are met before the patient receives their prescription, meaning that the only thing the patient is responsible for is payment, not the process.
4. What are the possible outcomes of this process?
There are several possible outcomes:
1. The patients insurance will cover the entire cost of the prescription(s) and the patient will not have to pay a co-payment
2. The patient’s insurance will partially cover the cost of the prescription(s) and they will be responsible for the co-payment
3. The patients insurance will not cover the cost of the prescription(s) and therefore, the pharmacist will either have to call the doctor to
Roles and responsibilities of the person dispensing the medication is to check to make sure the prescription is legal and signed by a qualified person, ensure there are no errors, to dispense the right quantity and dose of medication, make sure the medication is clearly labelled with the instructions of the dose, the name of the medication and person, provide advice and treatment for any minor illnesses and health concerns. Pharmacies will also provide a repeat prescription service.
Medicare Parts A and B. There is a monthly premium for this coverage (Medicare 2013 costs at
is that pharmacists prepare medications and technicians simply deliver them. This view of their job is both accurate and inaccurate.
According to the Food and Drug Administration (FDA 2009), the wrong route of administrating medication accounts for 1.3 million injuries each year. An article published in September issue of the Journal of Patient Safety estimates there are between 210,000 and 400,000 deaths per year associated with medical errors. This makes medical errors the third leading cause of deaths in the United States, behind that comes heart disease and cancer. To prevent medical errors always follow the Three Checks and most importantly the Rights of Medication Administration. The “Rights of Medication Administration” helps to ensure accuracy when administering medication to a patient. When administering medication the administer should ensure they have the Right Medication, Right Patient, Right Dosage, Right Route, Right Time, Right Route, Right Reason, and Right Documentation. Also remember the patient has the right to refuse, assess patient for pain, and always assess the patient for signs of effects.
Once the patient comes through the door payment for services should be top of mind. All copayments and deductibles collected and any other non-covered expenses billable to the patient. The correct information is gathered and if all is handled initially properly within in the cycle the claim can go the workflow and payment received with minimum effort by human hands.
A health insurance plan pays for medical care only after the insured has first paid $500 out of pocket on an annual basis. The $500 annual cost is called
The policy states that if a patient has a copay or any other payment that needs to be made then he/she should do so at the time of their visit. This is usually done at the end of the visit encase the doctor orders any tests or lab work that might cost the patient more money. Patient’s should be informed of all or any charges and given an estimated cost.
Medicare part D is the prescription drug plan. Each plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different tiers on their formularies. Drugs in each tier have a different cost. For example, a drug in a lower tier will generally cost less than a drug in a higher tier. In some cases, if the drug is on a higher tier and the patient 's prescriber (the patient 's doctor or other health care provider who is legally allowed to write prescriptions) thinks the patient needs that drug instead of a comparable drug on a lower tier, the prescriber can ask the patients plan for an allowance to get a lower copayment. In the case of Mrs. Zwick Part D will cover the prescription drugs that she needs that are not covered by Medicare Part A and Part B unless those medications are on the unapproved list. What the patient will be responsible for paying
I also work closely with local pharmacies and doctors around the changing of a person’s medication. It’s important that we work closely together to ensure that the service user is having the correct medication at all times.
The insurance company is responsible for covering costs of care as well as you are. You will pay for the cost of seeing your PCP of your choice and you will get reimbursed for the services that you just received. It is a classic way of making sure that if you are really in need of seeing a provider then you will figure out a way to make that happen without incurring so much that the provider could be out money in the long run.
“This article discusses how Medicare Carriers and Fiscal Intermediaries use coverage determinations to establish medical necessity. When the condition(s) of a patient are expected to not meet medical necessity requirements for a test, procedure, or service, the provider has the obligation under the
- The carer’s role is to make sure that the service user gets their medication. It is his/ her responsibility to give the service user the correct medication, at the correct time with the correct dose. Everything that is given out must match what is printed on the MAR sheet and must be
The nurse must verify the physician’s medication order, including the dose and time, and then the pharmacy is responsible for their own checks and balances via the BCMA system in order to complete the dispensing phase of the medication (Gooder, 2011). The nurse enters the BCMA system with a login and password and is able then to see a list of the virtual due list for a specific patient. The computer on wheels is then taken to that patient’s room and the five rights of medication administration begin. As nurses, we are taught to use the five rights of drug administration are (1) right patient (2) right medication (3) right dose (4) right route and (5) right time. By scanning the barcode on the patient’s hospital identification band, the nurse then asks for the patient to verbally state their name and date of birth, which can be verified by the nurse on the virtual due list and then choses the medication that are due for administration at that time. The medication is dispensed and the nurse is able to scan the barcode on the medication, the scanning triggers the automatic documentation of the medication given (Kelly, 2012).
* Medicare/Medicaid, to be sure the doctor is not banned from caring for Medicare/Medicaid patients
After the Pharmacy technicians checks the solution for exactness, and may convey it to the patient. The expert then duplicates the data about the endorsed pharmaceutical onto the patient's profile. Specialists likewise may amass a 24-hour supply of medication for each patient. They bundle and mark every measurement independently. The bundles are then set in the drug cupboards of patients until the administering pharmacist checks them for precision, and at exactly that point is the prescription given to the patients.