Best Practices for Building the Pharmacy's Infrastructure

About

  • This section are best practices that help to support the Change Packages and other Implementation guides.

Digital Data Logger (DDL) [updated 1.12.2021]
  • A DDL is required for each storage device for COVID-19 Vaccines.

  • We will continue to update as we receive new information. If you know of DDLs available, please email cdc@cpesn.com with company name and website to order or contact.

  • For requirements of DDLs, view the December Change Package on the vaccine home page.

Best Practice: Reach out to your local Health Department to be a resource for Phase 1
  • Click the link to view sample talking points created by CPESN Iowa in order to determine if they need or would like assistance in an earlier phase of the vaccine rollout.

    • CPESN Pharmacies that are utilizing CPESN USA as the Federal Pharmacy Partner during Phase 2 still applies.

    • This will allow you to be involved in the vaccine earlier on. 

  • Utilize these ideas to create your own script and reach out to your local Health department.

Best Practice: Billing the Medical Benefit (not the PBM) for COVID-19 Vaccines

COVID has brought new opportunities and has more pharmacies interested in services that can be billed and paid for outside the PBM, from the medical benefit. COVID Vaccines are within this category.

Medical Billing Pathways: 

  1. Medicare Part B (The information provided below is only for the Medicare Part B Pathway)

  2. Medicaid

  3. Commercial

  4. Uninsured

Medicare Part B Payment 

  • Click here to view the CMS Medicare payment rates for COVID-19 vaccine administration.

 

Step 1: Ensure that your Pharmacy is enrolled with Medicare Part B

  • If you are billing for immunizations (e.g., flu, pneumococcal) through Medicare Part B for reimbursement, you should have a PTAN for “Pharmacy” or “Mass Immunizer (Roster Biller).” 

  • Double check through your PECOS online account.

Step 1a: Sign-in to your PECOS online account

Step 1b: Determine your “Existing Enrollments”

  • If your existing enrollment is not “Pharmacy” or “Mass Immunizer (Roster Biller),” then you will need to “Create Initial Enrollment Application” for this enrollment.

  • View enrollments (scroll down) to see how you are enrolled

 

Step 2: If your pharmacy is not enrolled with Medicare Part B, begin the enrollment process

  • In order to enroll with Medicare Part B, the process can be started by 2 different methods:

    • Online Form (Click here): Enroll through PECOS by clicking link to left 

    • Paper Form (Click here: Complete and mail the CMS-855B Form: Linked to the left

NCPA's 3-pager COVID-19 Billing and Reimbursement

Click here

APhA's Resource for Reimbursement for Administration of COVID-19 Vaccine(s) - What We Know

Click here

Commercial Payment

  • Pharmacies should consider workflow, transaction fees, reimbursement rates and timing of remittance when given the option of medical billing or PBM billing.

  • The following are the current options in the market place:

    1. Change

    2. EBS​

    3. FDS

    4. OmniSYS

  • Stay tuned for a comparison chart of these 4 platforms (or more if we become aware) ​

  • Next Step for the pharmacy: Begin researching your options and sign up with a medical billing platform, which will allow you to bypass the PBM for vaccine administration fees.

Uninsured - HRSA

  • Pharmacies must enroll as a provider participant with HRSA, check patient eligibility, submit patient information, and submit the claim in order to receive payment via direct deposit.

  • Click here to get the process started. The link includes a step-by-step instructions to enroll with HRSA. Also, you can view NCPA's 3-pager.

    • Step 1: Validate Taxpayer Identification Number (TIN)​ - this can take 1-2 business days.

    • Step 2: Set Up Optum Pay Automated Clearing House (ACH) - this can take 7-10 business days.

    • Step 3: Add provider roster - this can take 5-7 business days.

Best Practice: Obtain access to your State's Immunization Information System (IIS)
  • The link to the Overview of State IIS capabilities for pharmacists and pharmacy technicians is updated in real-team by local CPESN Network Leaders in their respective States. In addition, instructions and links are provided for how to get started with signing up with your State's IIS.
  • Continue to check back to find the most updated information.
  • In states that it is possible, both pharmacists and pharmacy technicians should have IIS access.  
Best Practice: Utilizing Appointment-Based Model Scheduling Platforms

Step 1: Choose a HIPAA compliant platform to use for scheduling appointments​​ ​

Step 2: Obtain access to the survey/appointment scheduling tool

Step 3: Create a workflow process for your pharmacy for the scheduling platform

 

 

comparison chart of scheduling platforms that was compiled via survey mechanism that was responded by the NCPA | CPESN Fellows, CPESN Pharmacy Staff Members who have been involved with COVID-19 Test Scheduling, and other Technology Partners.

Click here

PPCN & University of Pittsburg School of Pharmacy Developed Resource:

Click here

Best Practice: Identifying Certified Immunizers and Training Resources

Certified Immunizers Include:

  • Pharmacists

  • Pharmacy Technicians

  • Pharmacy Interns

Review the APhA Resource for Knowing the Facts on the requirements for vaccine. (Note: If you are partnered with CPESN USA as your vaccine administrator – view the details for certification proof / requirements on the CPESN/NCPA Learning Management System (LMS)

Click the link to the left to access APhA's "Authority to Immunize During COVID-19" Resource.

Best Practice: Certified Immunizer Training Resources
  • Check with your state associations for certification trainings for Pharmacists and Pharmacy Technicians

  • Student Pharmacists (and Pharmacy Interns) should have the certification from their school/college of pharmacy.

    • After contacting your state association and confirming that no other pharmacy technician training is available (State Associations have the ability to license all 3 options at a state-level), review the 3 options below.

The following training options exist:

  • American Pharmacists Association (APhA)

    • Composed of an online self-study component combined with a live seminar that teaches hands-on immunization techniques.

    • CE Hours: 6 Hours

    • Cost: Stay tuned.

  • CE Impact

    • This course consists of 3 hours of home-study, followed by a 2 hour live, virtual workshop. Pharmacy technician learners must attend the live, virtual workshop with a pharmacist immunizer present. As part of the live workshop, pharmacy technicians must demonstrate appropriate immunization technique by administering two injections to the pharmacist immunizer.

    • CE Hours: 5 Hours

    • Cost: $249

      • ​The CPESN Pharmacy discount code is available for the CPESN Pharmacy staff members by viewing the Workflows email send on 12/5/2020.

  • Washington State Pharmacist Association (WSPA)

    • This online course is designed to prepare pharmacy technicians to administer immunizations subsequent to a prescription or order from a pharmacist or other prescriber.

    • CE Hours: 12.5 Hours

    • Cost: $175 CPESN Pharmacy Member Cost

      • The CPESN Pharmacy discount code is available for the CPESN Pharmacy staff members by viewing the Workflows email send on 12/5/2020.

About CPESN USA

CPESN® USA is a clinically integrated, nationwide Accountable Pharmacy Organization  structured to advance community-based pharmacy practice. They empower community-based pharmacies that are deeply rooted within their community by fostering their ability to provide high quality, patient-centered enhanced services. CPESN® pharmacies integrate with other healthcare providers on the patient’s care team to coordinate medical treatment. The results are better medication adherence, higher patient satisfaction, and lower healthcare costs. You can find CPESN® networks of pharmacy providers in 45 states across America. To learn more, please visit cpesn.com.

About NCPA

Founded in 1898, the National Community Pharmacists Association is the voice for independent pharmacy, representing 21,000 pharmacies and employing more than 250,000 individuals nationwide. Independent pharmacy is a $75.8 billion marketplace. Community pharmacists are local health care problem-solvers who can customize solutions to local health challenges for groups and employers.   https://ncpa.org/

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