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#65959 - 07/06/15 12:30 AM Pharmacy refill requests
Bert Offline
Admin

Registered: 09/27/03
Posts: 11184
Loc: Brewer, Maine
Just wondering what others do with these whether they are by fax or via ePrescribe. My CMA goes into ePrescribe and refills every one of them. Of course, then they fill my inbox even though I don't want to see them.

Ironically, on the weekends, when I check faxes, I delete all of them. I just wonder how many of them are still being used, and I feel I would have a better idea of what my patients are doing if they called the office. Then again, maybe that would take more time.

It just seems that pharmacies must just hold onto these on their computers. They can't waste time and space filling them. I know that when I need refills I simply call my doctor and leave a VM. Of course, I cheat some by refilling them myself.

So, maybe it is a good thing. I haven't figured it out yet.

What do others do?
_________________________
Bert
Pediatrics
Brewer, ME

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#65961 - 07/06/15 03:11 PM Re: Pharmacy refill requests [Re: Bert]
mkweiss Offline
Member

Registered: 11/10/09
Posts: 265
Loc: Lincoln, NE
Bert, my practice regarding refills could not be more different than yours. At each visit, patients are asked whether they need any refills, if they need refills, at the visit, we provide sufficient refills to the pharmacy to last until the next visit. Patients have been instructed not to run out of medication, as if they have run out of refills it indicates a need for follow-up. The standard of care in this community is to see everybody who needs medications at least yearly, some medications and some conditions may require more frequent visits. I wish there was a way of blanket denying refills on Amazing Charts to get them out of my inbox, but matching prevents this, and some tend to be pharmacy mistakes. I am very annoyed by the following: Refill request, by fax when they could come electronically, and also any refill request for controlled substances as that would require a visit per office policy. Marlon

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#65962 - 07/06/15 04:53 PM Re: Pharmacy refill requests [Re: Bert]
Marty_PA Offline
Member

Registered: 07/07/10
Posts: 868
We have the patients contact the pharmacy when they need a refill. I still get faxes but not near as many as before. I have a form letter I send to the pharmacies stating that we request NO FAXED REFILL REQUESTS. Of course on occasion I get the phone call from a pharmacist stating they "can't" do electronic refill requests but I usually pull up a couple instances where they have done it before. This usually solves the problem.
_________________________
Marty
Physician Assistant
Fullerton, CA

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#65989 - 07/09/15 06:25 PM Re: Pharmacy refill requests [Re: Bert]
Tomastoria Offline
Member

Registered: 03/28/11
Posts: 586
Loc: Astoria OR
It must be very confusing for the pharmacies to have so many different systems.
We have not turned on electronic refill because one of our clinicians refuses to do electronic prescribing -- but also, it is sort of handy to use the faxed requests as an easy way to communicate with the pharmacists. We write notes back and forth when necessary.

Patients are told that ALL requests for refills must come from the pharmacy.
The pharmacy faxes us a refill request through updox.
We then authorize the refill, change the Rx as needed, or deny it by going to Rx writer in Amazing Charts.

It is pretty efficient, helps keep the med list updated, and allows for verification of patient status as well as two-way communication with pharmacist.
_________________________
Tom Duncan
Family Practice
Astoria OR

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#65999 - 07/10/15 10:39 PM Re: Pharmacy refill requests [Re: Bert]
Bert Offline
Admin

Registered: 09/27/03
Posts: 11184
Loc: Brewer, Maine
@Tom Just curious, why does your clinician refuse to use electronic prescribing.

___

I basically want to have all pharmacies not contact us about refills. I imagine just clicking on the refills saves my MA a lot of time. I think there are two threads on this, but I am not concerned about my MA doing refills. We generally do a certain amount of refills or scripts for certain amounts of time based on the med. Adderall XR only three months without being seen. Oxycodone, same way. Zantac and you get 11 refills. But, after that we must see you.

Ironically, I was glancing at this while in a room, and for the first time ever, the parents were complaining about how the pharmacy was calling them about one or two meds that need to be refilled every month. I mean if a patient is on Pepcid with three refills, and a month later, I change it to Zantac, I don't generally call the pharmacy to tell them to delete the Pepcid. Then the patient just stops taking Niferex, and we continue to get refill requests for that. Only the patient really knows when they are out of a med or what they are on. We then decide based on the history of their medications, etc. with the help of the pharmacy at times whether or not the patient should or should not get the med or needs to come in for a visit. Most visits are scheduled.
_________________________
Bert
Pediatrics
Brewer, ME

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#66001 - 07/11/15 12:54 AM Re: Pharmacy refill requests [Re: Bert]
ryanjo Offline
Member

Registered: 11/02/06
Posts: 1991
Loc: Central Florida
The chain pharmacies in my area all have gift cards or other inducements for transferring a prescription to them. Two results: skinflint patients call incessantly to switch pharmacies. And the pharmacies want to reauthorize the Rx as early as possible and then call the patient that their prescription is ready before they switch. As usual, docs are the only ones not benefitting.
_________________________
John
Internal Medicine

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#66004 - 07/11/15 02:54 AM Re: Pharmacy refill requests [Re: Bert]
Wendell365 Offline
Member

Registered: 11/09/05
Posts: 2177
Loc: Chicago, IL
Well, I for one, take the schizophrenic approach. Patients can leave a message for a refill. They are told it will occur within 24-48 hours. Some pharmacies fax orders and some send electronically. I prefer the latter.

I personally review the faxes that come in each day on the computer. It's very straightforward to do the refills right then when the fax pops up. I always do the electronic ones first, because sometimes there are both. I go through my messages and knock those out as well.

I have 1 MA I trust to do refills. She knows the rules well. Allergy meds less than 6 months since visit, no issues. NO antibiotics. Asthma preventive OK less than 3-6 (depends on the patient, she knows them well) rescue meds more than 6 months, or bounce it by me. Others, she will generally check with me first.
_________________________
Wendell
Pediatrician in Chicago

The patient's expectation is that you have all the answers, sometimes they just don't like the answer you have for them

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#66017 - 07/13/15 04:48 PM Re: Pharmacy refill requests [Re: Bert]
endo1 Offline
Member

Registered: 08/28/09
Posts: 40
Loc: Ohio
Just wondering if anyone else has noted this with electronic prescription refill requests - some pharms (examples Walgreens and Express Scripts) are sending duplicate requests (2-4 duplicates) in about 10 minute intervals or sometimes less time has lapsed.

We usually check electronic refills 1-2 times per day and at times there can be 4 duplicate request (from same pharm) in that short amount of time.
_________________________
One if by gland, two if by A1C...

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#66018 - 07/13/15 05:12 PM Re: Pharmacy refill requests [Re: Bert]
Bert Offline
Admin

Registered: 09/27/03
Posts: 11184
Loc: Brewer, Maine
We are thinking of just turning it off. Let them fax it.
_________________________
Bert
Pediatrics
Brewer, ME

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#66022 - 07/13/15 06:48 PM Re: Pharmacy refill requests [Re: Bert]
koby Offline
Member

Registered: 05/14/09
Posts: 545
Loc: Canaan CT
I love less then adequate interfaces smirk

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#66029 - 07/14/15 02:01 AM Re: Pharmacy refill requests [Re: Bert]
DocMartin Offline
Member

Registered: 09/29/06
Posts: 531
Loc: Downey, Calif
yes we are getting buried in duplicate refill requests. It started some time back with a few pharmacies and now is out of control. We did upgrade to 8.2 last Wednesday, but it seems to have started before this. Turning off the interface for now sounds like a plan.
_________________________
Martin T. Sechrist, D.O.
Striving for the "Outcome Oriented Medical Record".

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#66034 - 07/14/15 12:55 PM Re: Pharmacy refill requests [Re: Bert]
Wendell365 Offline
Member

Registered: 11/09/05
Posts: 2177
Loc: Chicago, IL
This has been happening for a long time for me sometimes I send both, sometimes not. Actually, I wish there was a way to delete an eRx if needed
_________________________
Wendell
Pediatrician in Chicago

The patient's expectation is that you have all the answers, sometimes they just don't like the answer you have for them

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#66037 - 07/14/15 02:16 PM Re: Pharmacy refill requests [Re: Bert]
koby Offline
Member

Registered: 05/14/09
Posts: 545
Loc: Canaan CT
what a useless P.O.S. E-Prescribing is I don't bother doing renewals hell it takes a few minutes to load, I've disabled the interface and will become a faxing fool

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#66038 - 07/14/15 02:26 PM Re: Pharmacy refill requests [Re: Bert]
Bert Offline
Admin

Registered: 09/27/03
Posts: 11184
Loc: Brewer, Maine
I am assuming that P.O.S. is an abbreviation for Point of Sale, lol. smile

It's funny. This is a great thread. I was the OP. Not that I am bragging. I still don't know if it good to just do the refills. Or have the patients call.

Does anyone do it through a portal?
_________________________
Bert
Pediatrics
Brewer, ME

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#71341 - 06/30/17 04:34 AM Re: Pharmacy refill requests [Re: Bert]
SoCalFP Offline
Member

Registered: 12/08/11
Posts: 32
Loc: Southern California
Updated inquiry: Would like option to set default response to eRx RF request to "Denied, have patient call" without ever needing to see or address or click on these.
Wondering how others handle this?

My situation:
At each appt, refills issued to last until next appt. Patients are expected to be seen for next rx. We don't want calls, faxes, or eRx RF requests adding to our task list everyday.

Perhaps I am misunderstanding this, but I seem to recall that if you turn off eRx Refills, either you can't eRx, or pharmacies will send them by fax instead.
Has anyone turned off eRx refills and still been able to eRx?
Does turning off eRx refills cause pharmacies to revert to faxing?

We don't want a deluge of faxes, each Updox fax costs us $0.02 to 0.04 and amounts to $1000 per year. It's cheaper to get them for free by eRx.
We get half a dozen or more eRx RF requests a day.
99% are not initiated by the patient. Nearly 100% of our local and mail order pharmacies use a server to automatically generate a RF request immediately after the patient picks up the last authorized refill (or even worse, at a calculated expiration date from the first issued eRx based upon the number or preauthorized refills), be it 30 or 90d, and they certainly are not "out" of medication. We get such request for meds the patient refused to ever fill 11 months ago, for meds long since changed due to allergic reactions, and for patients who died the previous year.
My preferences in order from preferred to less preferred:
1.) Administrative setting to automatically respond to all eRx "Denied, have patient call" without ever having to see another one of these in my inbox.
2.) Delete eRx RF request w/o responding (fewer clicks than responding, perhaps at risk of creating a long database table of unaddressed requests slowing things down, or pharmacy repetative resends, not that they don't already resend the denials to which we have previously responded)
I am hoping to avoid pharmacies switching to faxes which cost more to receive and more time to mark up in updox to deny.
_________________________
Mike
Family Practice

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#71343 - 06/30/17 08:09 PM Re: Pharmacy refill requests [Re: Bert]
Marty_PA Offline
Member

Registered: 07/07/10
Posts: 868
Hi Mike,

You can still Erx with refills turned off but you will get everything by fax. Refill requests are computer generated so often times you'll get refill requests even without the patient requesting them.
Marty
_________________________
Marty
Physician Assistant
Fullerton, CA

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#71345 - 06/30/17 08:13 PM Re: Pharmacy refill requests [Re: Bert]
Bert Offline
Admin

Registered: 09/27/03
Posts: 11184
Loc: Brewer, Maine
All I can tell you and this is directly from NewCrop, you are either set up for New or New/Renew.

If you change to the former, you get faxes.

But, NC can give you New only and get rid of the electronic renewals
_________________________
Bert
Pediatrics
Brewer, ME

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#71348 - 07/02/17 10:03 AM Re: Pharmacy refill requests [Re: Bert]
JBS Online   content
Member

Registered: 09/20/09
Posts: 2476
Loc: Baltimore, MD
Mike, I can confirm that if you turn off auto-refill, you get faxes.

Do you have a dedicated fax line (separate from Updox)?
If so, you can convert incoming faxes on that line to emails which are then imported to Updox. There is no charge for emails to Updox.

We have been doing this for years; it makes all faxes to us free (though you must have the line to get the faxes). This has saved us plenty over the years.

We never turned on refill-notification. I see the fax request in Updox, use eRx to fill it (when I want to) and trash it in Updox when I do not.
_________________________
Jon
GI
Baltimore

Reduce needless clicks!

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#71375 - 07/08/17 02:22 AM Re: Pharmacy refill requests [Re: Bert]
Bert Offline
Admin

Registered: 09/27/03
Posts: 11184
Loc: Brewer, Maine
Or you could contact NC, and they may be able to get you a better solution.

Mike, do you do all the refills, or is it done by your nurses? I don't even see them. My CMA does them. She is really good at it.

Another option: I remember once when my pharmacy sent a fax to my office for me with a medication on it that I didn't particularly want known by my staff. When I went into the pharmacy, I asked them to not fax refill requests for my meds. My pharmacist told me, it is either on or off. If you don't want your sent, then we have to turn them all off?

Have you tried calling the head pharmacist and ask if they could refrain from sending refill requests? If they can, then send a letter to all of them and follow-up by having your medical assistant call each pharmacy in your area and ask them to turn it off from their end.
_________________________
Bert
Pediatrics
Brewer, ME

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#71381 - 07/08/17 01:42 PM Re: Pharmacy refill requests [Re: Bert]
Sunil Offline
Member

Registered: 08/31/12
Posts: 187
Loc: fl, usa
Unfortunately doing prescription refills (faxed or electronic) is completed abused by all pharmacies (big chain as well as local)
Some of my friends, who are pharmacists have explained this.
The refill request is not sent by the pharmacist but by the computer software, when it is within 15-30 days of the last fill date.
It can be for a medication the MD has stopped.
It sends it both via fax and electronic, as the pharmacists pays not attention to this process.
This is a steady stream so that it propagates the pharmacist business, with no effort on his end.
Whereas the office has to look at it, evaluate whether Rx is needed and appropriate to fill and not get paid for any of this work.
THIS IS CRAZY AND UNFAIR TO PHYSICIANS

How many practices, charge patients or make them come into office just for the refill?
I have heard of a few that have implemented this process.

Can AC flag medications, that need refill in prescription writer, so that refills can be done at time of visit, without looking through an average of 10 medications and seeing their fill dates??

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#71439 - 07/21/17 05:47 AM Re: Pharmacy refill requests [Re: Bert]
SoCalFP Offline
Member

Registered: 12/08/11
Posts: 32
Loc: Southern California
Bert,

Thanks for your ideas.

I do all my own refills, 99% face to face during appointment quantity sufficient to last to next appt. 1% between appts, generally only to correct my errors, occasionally for the patient who cancelled their refill appt and in that case only after they have rescheduled within 4 wks and only enough to get to that appt. I try to never create a situation where I have issued a rx w/o sufficient quantities until next seen, as I find refill requests distracting from my attention to other tasks. The only time I tried to delegate refills to my MA was to have her deny all electronic refill requests with reason - have patient call (which is what I waste my time doing) - but I could never get Amazing Charts to allow her to do so. I have several MAs, and I would not feel comfortable delegating authority to actually grant a refill as I have many seniors in and out of the hospital and would not feel comfortable trusting them to read interval hospital notes to verify medications discontinued since last seen by other providers, although I try to keep this up to date reconciling med lists as I receive these reports.

We have made dozens of phone calls to many pharmacies requesting all refill requests be redirected back to the patient to call our office ("redirected" is an error, 99% robo generated by pharmacy, I agree with Sunil above) and stopped long ago because they were uniformly ignored by the pharmacists / pharmacies.
_________________________
Mike
Family Practice

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#71455 - 07/25/17 01:16 AM Re: Pharmacy refill requests [Re: Bert]
Bert Offline
Admin

Registered: 09/27/03
Posts: 11184
Loc: Brewer, Maine
I agree. Now with EPCS and even before with the hard copies, there would be a stack of scripts there. I would be so angry. I would have a meeting and go through each script and ask why is this do now? And, why this one. Some were our error. And, I guess it is difficult to have an ADHD patient or a Klonopin patient come in every month. So, we do three at a time.

One problem is MaineCare's great rule (although understandable) is incredibly problematic. Patient is on Vyvanse and they are getting 30 at a time. Then, you add methlylphenidate. They are only allowed 15. So, even if you give two, you are off. I now give 15, 15 and 30 and only two of the other scripts and have them come back in two months.

I will say that everything as far as this goes is a bit harder with peds. A parent runs out on Friday and pages me. Now, I refuse to write it for the weekend, and I remind her we don't refills meds after hours, especially CIIs. And I ask why they do not have any left. But, people are funny. It is just ingrained that they need the med. They are't going to die off the med. I just tell them, they can make it through the weekend, and you can come into the office on Monday at 7 am and pick up the med (two tablets), then we see you in two days for med check. But, parents are much more protective of their kids. I hope no offense. I see your point about the older patients.

I don't allow all my CMAs to refill. Only one. But, I don't like the electronic refills or the faxed ones. I delete all those.

But, all of the prescription VMs go to her. So, she may have ten waiting on her. Doing them electronically saves her a lot of time. But, patients and parents need to take responsibility.
_________________________
Bert
Pediatrics
Brewer, ME

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#71472 - 07/28/17 04:21 PM Re: Pharmacy refill requests [Re: Bert]
serene Offline
Member

Registered: 01/16/11
Posts: 214
Mike

We also deny all refill requests from the pharmacy. We don't have eRx refill so we just get faxes. An MA sends all these faxes back with a template saying patient needs to call us. Not all of these faxes result in the patient calling us to request it themselves.

I believe when you call the pharmacy and make the selection for refill, the pharmacy automatically sends the fax to us. I have done it myself in error.
_________________________
Serene
Office Manager
General Pediatrics
Houston, Texas

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