CMS (Centers for Medicare and Medicaid Services) has implemented a FIVE STAR RATING SYSTEM for all those providing care to those pts covered by Medicare/Medicaid/Medicare Advantage.
More STARTS means that the vendor GETS HIGHER REIMBURSEMENTS. Pts file GRIEVANCES to CMS ( www.cms.gov or 800-MEDICARE) about poor/unacceptable service will lower the vendor’s star rating… They get LESS MONEY !
There are a few disease states that CMS is focused on “helping” pts manage and part of that “management” is to make sure that you regularly take your medication. http://pqaalliance.org/measures/cms.asp
Barb was getting supper ready and HER CELL PHONE RANG and so I answered it… the woman on the other end ask to speak to me… and identified herself as working for our Part D provider.
All she asked for ID verification from me was the YEAR I was born in… not exactly EXTREME VETTING .. since she was going to discuss medication that I was taking.
She asked me if the number she called was a good number.. I told her NO.. since it was my wife’s cell phone .. which she seldom answers… you would think that she would then ask me a BEST NUMBER… but NOT HER…
She proceeded to inform me that one particular medications was DUE FOR A REFILL and named the pharmacy that we use. I knew that I had a few weeks worth of medication on hand and told her such… We normally get 90 days supply of chronic medication and the rules of this part D provider is that you can refill a prescription when 80% of the previous fill would have been taken… meaning that you can refill a prescription 18 days early.
It is normal for me if Barb has some refills… if I have some medications within the 18 day window… I will go ahead and refill them.. I did however look at the prescription bottle that they were referring to and technically I would not be out of medication for ANOTHER WEEK…
I find it hard to believe that this Part D provider really cares about my health, but more interested in their FIVE STAR RATING and their bottom line… since I have used this Part D provider for nearly FIVE YEARS and this is the first time that I have received a call from them about getting my prescription(s) refill on time.
My money is on that it would have to snow in July before they called me about refilling a controlled substance.
To me, this demonstrates how important it is for pt with Medicare/Medicaid/Medicare Advantage that they should file GRIEVANCES with CMS when they do not receive proper care from a hospital, prescription, Part D insurance, pharmacies and others. Remember healthcare is nothing more than a FOR PROFIT BUSINESS and putting “dings” on their FIVE STAR RATING … that will lower their reimbursements… is the only leverage a pt has.
Filed under: General Problems
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