As we welcome in the Year 2024, it is crucial for healthcare professionals and stakeholders to stay informed about the compliance changes in Medicare D pharmacy claims. These changes aim to enhance the efficiency, accuracy, and security of the claims process, ultimately benefiting both providers and patients. In this blog, we will explore the key compliance changes that will come into effect in 2024 and discuss their implications for the healthcare industry.
1. Electronic Prescribing of Controlled Substances (EPCS):
Starting in 2024, Medicare D pharmacy claims will require the electronic prescribing of controlled substances. This change aims to reduce prescription fraud and improve patient safety by ensuring that prescriptions are securely transmitted from healthcare providers to pharmacies. Providers will need to adopt EPCS systems that comply with the Drug Enforcement Administration's (DEA) requirements, ensuring the authenticity and integrity of controlled substance prescriptions. QRx has several effective edits to help the pharmacy identify Mid-Level prescribers with the DEA requirements that are taking effect in 2024.
2. Real-Time Benefit Tools (RTBT):
To empower both providers and patients with real-time information on drug costs and coverage, Medicare D pharmacy claims will incorporate Real-Time Benefit Tools. These tools will enable prescribers to access up-to-date information on formulary status, cost-sharing details, and therapeutic alternatives at the point of care. By having this information readily available, providers can make informed decisions that align with patients' preferences and financial capabilities. Many pharmacies operating systems have this capability but by adding QRx Pre and Post edits fills in the claim gaps these systems tend to have.
3. Enhanced Medication Therapy Management (MTM):
In 2024, Medicare D pharmacy claims will introduce enhanced Medication Therapy Management programs. These programs aim to optimize medication use, improve patient outcomes, and reduce healthcare costs. Providers will be required to offer comprehensive medication reviews, targeted interventions, and ongoing monitoring to eligible beneficiaries. Robust custom reporting focusing on medications and claim details in these programs can provide more in-depth insight for the pharmacy. Ask about our reporting today. By focusing on personalized care and medication optimization, these changes will help ensure that patients receive the most appropriate and effective treatments.
The 2024 compliance changes in Medicare D pharmacy claims mark a significant step towards a more efficient, secure, and patient-centered healthcare system. By embracing electronic prescribing of controlled substances, implementing Real-Time Benefit Tools, enhancing Medication Therapy Management programs, the industry can improve patient safety, reduce costs, and enhance the overall quality of care. It is crucial for pharmacy professionals to stay informed and adapt to these changes to ensure compliance and provide the best possible care to Medicare beneficiaries.
