Advance Beneficiary Notice (ABN):
ABN forms are used to notify patients that Medicare Part B may not cover one or more of their prescriptions. These forms help patients make informed choices about whether they want to pay for items or services out of pocket. Medicare requires that providers have a signed ABN on file, or money cannot be collected from the patient in the event that Medicare denies the claim. OmniSYS educates patients on the Medicare requirements and ensures complete ABNs are filed when appropriate.

Archiving and Imaging:
Outgoing documents are bar-coded so they can be easily scanned and imaged upon receipt. Once scanned, a soft copy attaches to the patient’s profile and is available for pharmacy review via the web browser. Archived and Imaged documents are also available and easily accessed in the event that medical necessity documentation is requested to support a Medicare audit. Hard copy documents are picked up and archived via an off-site, secure documentation storage company.

Assignment of Benefits/Medical Release Authorizations:
Patient authorization is required for each item billed to Medicare. OmniSYS’ Patient Outreach services allow additional opportunity to obtain complete beneficiary information including secondary insurance status.

Audit Compliance Tool:
OmniSYS offers a service to conduct random desktop compliance audits and provide formal compliance reports. These quarterly audits review documentation for accuracy and completion. Audits include documentation for Physician Written Orders, Certificates of Medical Necessity, Physician Narratives, Delivery Slips, Physician Progress Notes, Diabetes Testing Logs, and other required medical records to support dates of service or quantity billed.

Diabetes Testing Logs/Physician Progress Notes:
Diabetes supply overutilization claims require documentation to support that the patient is testing at the prescribed frequency. Medicare audits for diabetes overutilization claims increased by over 50% in 2008. OmniSYS’ comprehensive Diabetes Testing Log Outreach services ensure you remain compliant and avoid recoupment for invalid claims.

Medicare Audit:
Medicare randomly audits claims to ensure that the patient is testing as prescribed and the pharmacy is dispensing accordingly. OmniSYS’ Medicare Audit services include obtaining, coordinating, and submitting all required supporting documentation, as requested by Medicare. In addition, OmniSYS completes redetermination, re-opening, and reconsideration forms in the event that the claim is denied, pending additional documentation.

No-Charge Meter Intake:
Part B patients who receive No-Charge Meters from various Blood Glucose Meter manufacturers can have their test strip claims mistakenly denied by Medicare, as Medicare may not have a record of blood glucose meters paid for outside of the program. OmniSYS’ can update profiles to accurately record No-Charge Meter information to ensure claims are paid for patients who receive No-Charge Meters.

Physician Narratives:
Respiratory medication overutilization claims require documentation from the physician to support the quantity prescribed above standard utilization. OmniSYS’ Physician Outreach services allow the pharmacy to focus on filling prescriptions, while OmniSYS manages the necessary documentation requirements to meet medical policy guidelines.

Physician Written Orders (PWO):
Compliant Written Orders signed and dated by the treating physician must be on file and meet detailed criteria required by Medicare to support claim submission to Medicare. OmniSYS’ PWO Outreach services ensure consistency between PWO and information submitted by the pharmacy in the claim.

Transfer of Title Notice:
Medicare requires that providers notify patients when rental fees paid on equipment effectively transfer ownership of the equipment to the patient. OmniSYS can track capped rental claims and monthly payment status leading to ownership based on Medicare guidelines. Once an item changes ownership, OmniSYS notifies the patient that the title has been transferred.

Voluntary Refund Forms:
In the event a payer requires a pharmacy refund, (i.e., a patient failed to pick up an item, returned an item, etc.), OmniSYS will complete the Refund Form, attach the Explanation of Benefits and forward the information the pharmacy. The pharmacy is then able to write a check, attach the completed documents, and forward the refund to the payer. OmniSYS tailors this service to the requirements of each jurisdiction to respond in a timely manner.