Controlled Substances
Are CMA's able to send controlled substance medication refills to the pharmacy?
No, all controlled medications need to be refilled by PCP
A patient calls the office requesting a referral to be sent to dermatology, has UHC PPO for insurance and an appointment on 12/15/2025. Does the patient need a referral authorization?
No, patient has UHC PPO not HMO
Where do you find what time you open or close?
The Schedule
When completing documents, what order is correct?
Oldest to newest
How many days in advanced do you prep?
4 days in advanced
what SOP are you using for controlled medications?
.SOPcontrolledmedication
6 visits
What are the duties of PCR opener?
Arrive 30 minutes prior to clinic start time. Refresh and review schedule for the day, ready to greet, welcome, and check in patients as soon as they arrive
When should documents need to be completed?
must be completed by the end of the week
When should you get patient's insurance card?
when there is no insurance card in chart or if insurance has been changed. This is checked during prepping
Do all control medications require a diagnosis, if yes, why and how do you find it?
Yes, The code proves the drug is prescribed for a valid condition (ADHD, chronic pain, anxiety) rather than for illicit use. You can find it in the encounter note.
If authorization is needed for Fee for Service, who do we send referral to?
PCR Inbox
What are the duties of the MA opener?
arrives 30 mins before 1st patient, Opens the supply and hallway door, unlock cabinets, calibrate spiro, take out caddies. complete next day prep and escribes once prep is complete.
If duplicates are in document folder, can we close them out?
Yes, make sure the original document has been completed before reviewing document.
What is the process for the 15 min arrival time?
Remind the patient that they should arrive 15 minutes prior to their appointment time
May be asked to be rescheduled or worked in
notify provider in teams of arrival time and provider will make decision.
What is the process for a controlled medication refill?
create a te (if one not created), timestamp, use .sopcontrolmedication, click medication needing to be refilled, make sure to populate the rx and send to provider on fill date.
Referral is created for a VB UHC MA HMO, what is needed to complete the referral if no authorization is needed?
eval/tx, please send us your consult notes, Timestamp of provider, 6 visits, .sopnoauthrequired
What is the process for PCR Closer?
print out end of day reports, add total, get deposit slip, email end of day to accounts payable, CM and Lead CMA.
write total in the book for Frank to pick up next day
What is the process for completing a prior auth?
Double check if a PA has already been completed, contact pharmacy if no key has been provided and Use cover my meds to complete PA.
What should be asked when a patient is checking in?
demographics, insurance, phone number, HIPAA/consent forms, pharmacy
what is the new process for Dr. Ortiz's patients requesting control medication refills?
contact patient, inform them Dr. Ortiz is ONLY filling controlled medications on days 1,2,3, and 15,16,17 of the month. If pt is able to wait until those dates, hold TE and send to Dr. Ortiz on day listed above. If patient cannot wait, will need to be seen in office (no televisits are allowed) for refill and Dr. Ortiz will discuss the new process with them. May use SDA slot per Dr. Ortiz if needed.
Referral received in documents for a VB UHC MA HMO for authorization for additional procedure codes from specialist. What are the steps are used to obtain authorization?
Fax back redirect letter to specialist
What are the closing steps for Back Office closers?
Make sure all TEs are touched, urine is scratched off ready to be thrown away in toilet, rooms are cleaned, cabinets and doors are locked, labs are put away (lockboxes), triage machines are plugged in, instruments cleaned and placed in autoclave (if any used) make sure no labs are in centrifuge or anywhere in the lab unless in the fridge or freezer (freezer-Friday) check temp log is completed
If PA was denied for a medication what should you do?
Create a TE letting the provider know PA has been denied. Provider will either appeal PA or will send in another medication
what questions are asked during appt prepping?
Appt Prep
Insurance verified:
Needs:
Spoke with patient :
details of phone call :