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How Can I Prepare for a PBM Audit?
The role of a pharmacy benefit manager (PBM) is one that is quite important in the health industry. PBM’s serve as the middleman between pharmacies and insurance companies and are necessary for a pharmacy to operate. Every once in a while, your PBM will contact you to inform you of an audit to ensure rules are being followed and business is being conducted as it should be. Being audited by anyone can be a nerve-wracking experience, especially if that audit is conducted by your PBM. A catastrophic PBM audit could leave lasting effects on your business. If you have been notified of an upcoming PBM audit, here are a few tips to help you prepare for your audit:‘
- Ensure you are there for the audit. When you receive notice of the audit, the exact date and time will also be mentioned. Make sure you are in the pharmacy at that time and that you are free to work with the auditor while they are there.
How Can My Dental License Be Put into Jeopardy?
Each year, the Illinois Department of Financial and Professional Regulation (IDFPR) issues, renews and reinstates hundreds of licenses to those in the dental field. To be eligible for a general Illinois dental license, you must complete years of schooling, have years of clinical training, and pass both a national and regional dentistry test. After putting so much effort into getting your license to practice dentistry, the last thing you would want to do is jeopardize your license by committing a simple violation. Depending on the violation, you could face disciplinary or non-disciplinary action and fines of up to $10,000 per offense.
Common Violations That Could Affect Your License
To practice dentistry in Illinois, you are required to have a valid Illinois dental license. The IDFPR is the licensing entity that determines whether or not you can practice dentistry. There are a number of violations that could cause the IDFPR to refuse, revoke or suspend your license to practice dentistry. These violations include:
What Is a Prescribing Psychologist in Illinois?
There are many professions in Illinois and across the country that require you to hold a license to practice your trade. The Illinois Department of Financial and Professional Regulation (IDFPR) is the governing body that oversees all of the licensing in the state, including the licensing of clinical psychologists and prescribing psychologists. A prescribing psychologist is a licensed clinical psychologist that has been granted permission to prescribe mental health medication in certain circumstances. A clinical psychologist is an individual who holds a doctorate degree, has completed years of supervised experience and an internship to practice in Illinois. A prescribing psychologist has to go through specific schooling and training in order to practice.
The Reason for Prescribing Psychologists
Most people who take medication for mental health issues have gone through the usual process. They see a psychologist on a regular basis for talk therapy, but the psychologist suggests that the addition of medication may help, though they are unable to prescribe it. Most of the time, a person’s primary care physician is who prescribes medication for mental health issues, though they do not have nearly as much training in the specialized field of psychology and mental health disorders. The creation of prescribing psychologists helps to ensure the patient has both the therapy and medication that they need and takes an integrated approach to solving that issue.
Three Mistakes to Avoid When Applying for VAWD Accreditation
Wholesale drug distributors are actually pretty strictly regulated in the United States. To be a wholesale drug distributor, you have to be properly accredited and licensed and you must also pass a series of tests and inspections. The Verified-Accredited Wholesale Distributors (VAWD) was created by the National Association of Boards of Pharmacy (NABP) and helps ensure the quality of drugs that are in the U.S. marketplace. This is accomplished by requiring distributors to pass a variety of tests and criteria in order to receive the accreditation. Here are a few mistakes you should avoid making if you are trying to receive VAWD accreditation.
Not Properly Preparing
The accreditation process is one that is extremely thorough and often complicated. There are various documents that you must have on hand when you apply for your VAWD accreditation and you even have to have a complete business plan and Standard Operating Procedures (SOP) written out that prove that you will be compliant with all federal and state laws and requirements. Not having proper planning before you even begin the process can spell disaster.
Understanding Licensing Requirements for Illinois Social Workers
Social workers are all around us -- they can be found in schools, hospitals, mental health clinics, the military, private corporations and even in private practices. The purpose of social work is to help people and promote overall well being, which is why social workers are licensed and regulated in the state of Illinois by the Illinois Department of Financial and Professional Regulation (IDFPR). Illinois provides two options for licensure in the state: licensed social worker (LSW) and licensed clinical social worker (LCSW). These licenses are similar, but there are limitations on what each type of license permits a person to do, which is also why the requirements for each license are different.
Licensed Social Worker
If a person holds an LSW, they are permitted to practice social casework, social group work, community-based social welfare, social work education or social work research. LSWs are permitted to administer social services to individuals, groups or communities, along with engaging in clinical social work, as long as it is not conducted in a private, independent practice.
Reinstating Your Medical License After a Criminal Conviction
Becoming a physician is a long and difficult process. You go to school for nearly 10 years, hold internships, practice medicine as a resident and you might even further your career by specializing in a specific field, which takes even more training. The last thing you would want is for something small and unrelated to put your medical license in jeopardy. In the state of Illinois, physicians are held to a higher standard than is the general population. Physicians are expected to be upstanding citizens, which is why even a small and/or unrelated criminal charge can have a large impact on one’s medical career. If you are convicted of a crime, your license will probably be revoked, but there are things you can do to mitigate the situation.
Crimes and Your Medical License
Prior to 2017, any felony conviction meant an automatic denial for new medical license applicants or revocation for current medical license holders. Under the current law, any person who was convicted of a criminal charge may petition to have his or her license reinstated if five years have passed since the conviction or three years have passed since the individual was released from confinement, whichever is later.
Four Ways You Could Lose Your Nursing License in Illinois
Most occupations in the healthcare field require specialized education and training that can take years and years of hard work. The last thing you would want to see happen is for all that work to be taken away from you because of one mistake. In the state of Illinois, there are certain rules and laws that you must follow when you are a nurse. A violation of these rules could result in disciplinary action, such as probation, suspension or other reprimanding actions. For some offenses, you could have your nursing license revoked, meaning it is permanently taken away from you. This can be devastating for those who have made their career from nursing. Here are a few ways in which your nursing license could be taken away:
Refusal to Participate in a Recovery Program
Part of a nurse’s job is to dispense medication to patients. This means they have almost unlimited access to certain drugs, which can be tempting for nurses who have addiction issues. If it is discovered that a nurse has an addiction issue or abuses alcohol, the Illinois Department of Financial and Professional Regulation (IDFPR) will often suspend his or her license until they have entered an addiction recovery program. Nurses who refuse to enter a program or who cannot complete the program successfully may lose their nursing license.
Self-Audit Practices to Protect Yourself in Case of a Medicare Pharmacy Audit
The world of healthcare is constantly changing. For some pharmacies, keeping up with these changes can be difficult, particularly for independent or small pharmacies. The Centers for Medicare and Medicaid Services (CMS) is the governing body that oversees the practices of different medical professionals who provide services covered by Medicare and Medicaid. One of the goals of CMS is to try to cut down on healthcare fraud and they do this by conducting audits to ensure providers operate within the legal standards. CMS audits can sometimes produce less-than-favorable results that could seriously affect the operation of your pharmacy and its financial wellbeing. Here are a few things you and your employees can do to minimize any errors or inadvertent fraudulent practices:
- Ensure you are meeting requirements for both non-controlled and controlled substances. When filling and dispensing a prescription, there are certain pieces of information that you must collect, plus a few special pieces of information for controlled substances. To fill a prescription, you must have the prescriber’s signature on the prescription, the name, strength and dosage form of the drug, the directions for use and the number of pre-authorized refills (if any). For controlled substances, the prescriber must have the appropriate authority to prescribe such a drug and the prescriber must manually sign the prescription on the date it was issued.
Understanding Disciplinary Actions a Licensed Professional Could Face
Each year, thousands of licensed professionals receive some sort of disciplinary action against them in Illinois. The Illinois Department of Financial and Professional Regulation (IDFPR) is the regulating body for many of Illinois’ professionals, including physicians, nurses, pharmacists, chiropractors and dentists. These professionals are held to a higher standard than other citizens and they each have certain rules they must follow. Breaking those rules could result in disciplinary action, which comes in a variety of forms. If you are a licensed professional and you are facing any of these actions, it is crucial you understand exactly what they mean.
Types of Disciplinary Actions
Once a complaint has been filed against you, the department may or may not launch an investigation into the complaint. The investigation could result in nothing happening, but it could also result in some form of discipline. Here are a few common ways the IDFPR could discipline a licensed professional:
Understanding the Complaint Process Against Illinois Physicians
According to the Illinois Department of Financial and Professional Regulation, there are around 3,000 complaints filed each year against doctors and other medical professionals. There are many reasons why a physician or medical professional could have a complaint lodged against him or her -- and there are 50 different actions specified in the Illinois Medical Practice Act of 1987 that could result in disciplinary action against a physician. Some of the most common complaints include unprofessional conduct and substandard care, but any complaint is a possible threat to your medical license. It is important to understand the process of a complaint if you have one filed against you.
Initial Claims Are Made
When an initial claim is made to the Board about allegations against a physician or other professional, the complaint process is started. The disciplinary board will provide the complainant with information about the complaint process and information on whether or not the claim has become a complaint and why. The claims are forwarded to the Chief of Medical Investigations to determine whether or not the claim will become a complaint.
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