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- Issue 81: April 2009
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Medicare RMMR Payment Debacle

Stephen Carbonara
From an Independent Professional Pharmacist Perspective

Issue 76: October 2008
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This month I write about an issue that I'm sure will get resolved. I however still feel the need to share the particulars of this issue with fellow i2P readers for the sake of comprehensive professional collaboration.
This topic concerns accredited pharmacists who provide medication review services to residential aged care facilities.

I have recently suffered a Medicare payment rejection for an RMMR service for the reason that a previous pharmacist-initiated RMMR had been performed for the resident within the previous 12 months.
However in this case, the resident in question is a recent admission to the facility; and as such any information regarding any prior RMMR is not easily obtainable.
This is particularly bothersome considering that the standard service agreement recommends that each new resident receive an RMMR within 6 to 12 weeks of admission!

There are also other complexities surrounding this issue.
I realise that GP-initiated
RMMRs will be paid; however in this type of case the GP concerned may not be willing or able to provide a formalised referral.
Consider the situation where I may ring a GP and say, "Excuse me doctor, do you mind signing a piece of paper for me, if you're not too busy, so Medicare can give me some money?" I doubt GPs have vast quantities of available time at their disposal to deal with a bureaucratic anomaly.
Also, the idea that a previous facility (or previous facility's accredited pharmacist) should be contacted to confirm the date of any prior RMMR is similarly impractical.
I believe that sharing information of this confidential nature over the phone, on request may constitute a breach of privacy; particularly considering that this information is unavailable to providers through Medicare.

This situation is another example of bureaucracy at its best.
As a diligent service provider I attempt to follow the recommendations in my service agreement with the facility, only to find that the payment for my time will not be honoured.
Furthermore when contacting Medicare, I discover that this issue is not an isolated incident, however there still does not exist a formal appeal process that can be actioned. Rather I am informed that (essentially) the wheels of bureaucracy must be allowed to turn unobstructed until a solution is reached.

I plan on campaigning for a system where all RMMR payments for new residents of a facility will be paid. This is the only commonsense option that is in the best interests of the patient.

Stephen Carbonara.


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