New CSS program helps PartD sponsors meet CMS drug overutilization requirements
"Effective, concurrent DUR has not been fully implemented across the Part D program." - CY2013 Final Call Letter
BUFFALO, N.Y., June 20, 2012 /PRNewswire/ -- Those working in Medicare programs have full schedules, filled with program submission rules, standardized formats, policy changes, data validation audits, on-site audits and more. Just when it seems there aren't enough hours in the day to get it all done, the Centers for Medicare & Medicaid Services (CMS) is adding even more oversight by getting tough on prescription overutilization by Medicare beneficiaries, and Clinical Support Services, Inc. (CSS) has a new program to help identify and track those most at risk.
CSS's new program helps Medicare plans offering prescription coverage to meet CMS's new requirements for retrospective drug utilization review by identifying "patterns which suggest that the identified patients may be at risk of overutilization. Part D sponsors should create and monitor Part D utilization reports to identify patterns of apparent duplicative drug use over sustained periods of time and/or across multiple drug products," according to the CY2013 Final Call Letter.
CSS's program reviews pharmacy claims and plan eligibility data monthly, then flags patients of concern by using predetermined selection criteria such as number of prescriptions filled in a 30-day period for frequently abused drug classes; number of physicians prescribing medication for that patient; and number of pharmacies filling prescriptions for that patient. Medicare plans receive a data report to determine the best course of action for that patient.
"Medicare plans have had even more responsibility thrust upon them," said James Notaro, RPh, Ph.D., CSS president. "This is a serious problem that needs serious consideration."
About CSS: Founded in 1999 by pharmacists and technologists, CSS is staffed by experienced clinicians, software developers and operations personnel who develop innovative and proprietary technology tools that improve patient care while providing financial value. At the heart of the business is Medication Pathfinder™ – built in a S-O-A-P (Subjective-Objective Assessment Plan) Note structure to help pharmacists move more quickly through complex patient Medication Therapy Management (MTM) assessment procedures. Structured data storage is one of the main differentiating features of the MTMPath system. Additional CSS software solutions include iDealTherapy™ and Star Ratings Booster™.
Clinical Support Services, Inc.
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James Notaro, RPh, Ph.D.
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