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davidtrump

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  1. Every day, thousands of intelligent Americans respond to work at home medical billing jobs or medical billing jobs from home ads because: Let's face it, the present economy is making the average person look for ways to supplement or create new revenue streams to help them get through this crisis.

    The work-at-home industry over the last few years has opened up several avenues for people to make a few extra dollars (for some thousands) per month and who can turn down work at home medical billing jobs when they say you can earn $40K within your first year?

    Now let's put logic to work here for a minute. A medical billing job is when you are hired by an employer to do the many functions of medical billing for a set amount of time, for a set amount of money and the work is done within the confines of the employer's office. If that employer has a telecommuter program in place, then once you prove yourself trustworthy enough in the office (usually within 6 months to a year), they may allow you to work at home doing medical billing work instead of going to the office.

    That is the only, I repeat ONLY way you are going to get a work at home medical billing job.

    Those ads for work at home medical billing jobs that you see in the papers and on the Internet are called “opportunities” and almost all of them are misleading because they make it sound like you will be working for them doing medical billing from home as a job. The truth is that these vendors are in the business of selling you the home-based medical billing business model, a few of the things you will need to run the business, a useless list of physicians that they claim are in dire need of your services, and, if you are lucky, they may provide you with some medical billing education so you feel you understand what you are doing.

    Now once again, let's put logic to work. Has anyone you have ever worked for asked you to purchase their business model before you are considered an employee? The only reason you would need to implement a business model is if you are starting your own business, so why would anyone think that what they are getting into is a work at home medical billing job if, in fact, they end up being the owner of the business?

    One thing that needs to be made clear is that there are several medical billing opportunity vendors out there that have and continue to support those that want to start their own home-based medical billing businesses, but they don't make it sound like they are offering you a work at home medical billing job.

    If you take heed to the above then you will not fall victim to misleading ads for work at home medical billing jobs, nor to the companies that spend millions to make sure that they keep their sales funnels full of unsuspecting, unknowledgeable and desperate-for-a-change individuals. Unfortunately, these very people are the most susceptible to falling for work at home scams.

    The medical billing from home industry is made up of those people that took the time to start, open, find their own clients and operate their own business without utilizing the traditional brick and mortar facade. Or, they are experienced medical billers and coders who have proven themselves to their employers and have been allowed to work from home. That's it, in a nutshell.


  2. Medical Billing as a Work at Home Job

    Medical billing professionals are usually able to work independently from home since medical billing software can easily facilitate electronic billing of patients, health insurers and government health agencies like Medicaid and Medicare from through their home computers. However, most of these opportunities are for experienced medical billing professionals only. 

    Medical Billing as a Home Business

    A medical billing or medical coding home business could have good potential for success and have been growing in popularity. One of the reasons for this growth is the wide availability of online training in medical billing and medical billing software, as well as the increased need to transfer medical records into digital form.

    Like any home business, starting a medical billing and coding home business is much easier if you already have some medical billing experience to your credit and you've received full training before you decide to go it alone. Additionally, you'll have gained some contacts during your medical billing employment that will help in establishing your customer base. 

    Other things you need for a medical billing or home business include:

    A business license. Check with your local Chamber of Commerce and with your state officials about licensing requirements.

    A computer, printer, and fax, as well as accounting and billing software and fast Internet connection

    Medical billing and coding software, which ranges between $500 and several thousand dollars. Much of it should be geared toward processing HCFA 1500s, the standard claim form used by health plans.

    Medical billing and coding reference books. The recommended ones are the ICD-10, CPT and HCPCS Expert 2000, plus the CDT-3 for dentists.

    Marketing Your Medical Billing Home Business

    Like any service-based home business, getting your first clients may be your biggest challenge. If you're coming from a medical billing background, you can ask your former employer to be a client or network with the people you know in the industry to find work. Visiting or calling local doctor's offices, clinics, and hospitals can be another way to find work. Don't forget that many mental health professionals also need billing and coding services.

    Medical Billing Clearinghouses

    An electronic medical billing clearinghouse acts as a middleman that takes electronic medical claims information and then submits it electronically to insurance companies the medical billing clearinghouse contracts with. Many who run medical billing businesses, however, fail to take advantage of this time saver in their medical billing and coding practices.


  3. The need for medical records and health technicians, such as medical billing and coding jobs, is expected to grow 15% from 2014 to 2024, according to the Bureau of Labor Statistics, making it a viable home business option. Medical records specialist earn a median pay of $35,900 per year, which isn't bad for a profession that requires little education or training.

    Medical billing and coding lends itself well to working at home, and many in the medical billing profession have been able to do just that, either by setting up a home business and working for themselves with independent physicians as their clients, or by working from home in medical billing jobs with larger healthcare firms that make and track medical billing work assignments electronically. Medical billing and coding professionals may also be hired by insurance companies, pharmacies, and related companies and even the government for their expertise.

    Pros of Medical Billing and Coding

    Can be done from home as a business or a telecommuting job.
    Healthcare is a trillion-dollar industry that is always in need.
    Help with billing and coding continues to grow as health facilities and workers move toward electronic billing and filing.
    Doctors are happy to outsource medical billing to free them up to do what they do best, provide services.

    Cons of Medical Billing and Coding

    It can be difficult to break into the industry as most medical and health facilities have a source for their medical billing and record keeping.
    Most sources of work will want you to be certified as a medical biller and/or coder.
    There is medical billing job and certification scams you need to watch out for.

    Required Skills for Medical Billing and Coding

    Currently, there are no set educational standards for the medical billing profession. Many employers who offer work at home medical billing jobs look for some level of formal medical billing and coding training through an accredited vocational or career training school, along with actual experience in a medical billing office. Formal accredited programs may take from as little as nine months to as long as two years or more and may also offer assistance with career placement.

    Educational Requirements for Medical Billing and Coding Professionals

    Medical billing requires a fairly strong knowledge of medical terminology, anatomy, knowledge of how to properly complete various forms, and industry coding for medical procedures. If you don't have that type of experience, you can take a course and get certified as a medical biller and coder. You just need to be sure you choose a reputable program.

    Medical billing expert, Paul G. Hackett says that "Almost 80% of people end up choosing the wrong types of online medical billing courses." He also advises that there are only seven medical billing training subjects you should look for before enrolling in any medical billing training program. He calls these his medical billing "essentials" that every medical billing training program should have.

    In addition to knowing what to look for when you're researching medical billing and coding training programs, you also need to know what to avoid. Medical billing training expert, Paul G. Hackett believes that by learning what you need to avoid before signing up for a medical billing program is easier to remember that knowing what to look for when you are shopping for an online medical billing study program.

    Unfortunately, because of the growing popularity of medical billing home businesses and because it logically makes sense that a medical billing career might be one with strong opportunities to work from home, the industry is loaded with scams like "You Can Earn $50,000+ Processing Medical Claims From Home. No experience necessary!"

    Scams also abound to try to get you to purchase training, software, marketing materials, and lists of doctors. Additionally, some medical billing software scams try to sweeten their offers with discounted clearinghouse services if you buy medical billing software from them. Any of these scams can cause you to part with your hard earned money and waste your time getting established in the medical billing and coding profession.

    Other needed skills include a strong level of computer skills and a typing speed of at least 35 words-per-minute, as well as good customer service skills to deal with patients who may be under stress, physician and hospital billing staff, and other medical personnel.


  4. Medical billing services

    In many cases, particularly as a practice grows, providers outsource their medical billing to a third party known as medical billing companies who provide medical billing services. One goal of these entities is to reduce the amount of paperwork for a medical staff and to increase efficiency, providing the practice with the ability to grow. The billing services that can be outsourced include: regular invoicing, insurance verification, collections assistance, referral coordination and reimbursement tracking. Healthcare billing outsourcing has gained popularity because it has shown a potential to reduce costs and to allow physicians to address all of the challenges they face daily without having to deal with the daily administrative tasks that consume time.

    Medical billing regulations are complex and often change. Keeping your staff up to date with the latest billing rules can be difficult and time-consuming, which often leads to errors. Another main objective for a medical billing service is to use its expertise and coding knowledge to maximize insurance payments. It is the responsibility of the medical billing service you choose to ensure that the billing process is completed in a way that will maximize payments and reduce denials Payment posting important part of the medical billing.

    Practices have achieved significant cost savings through Group purchasing organizations (GPO), improving their bottom line by 5% to 10%.


  5. Payment

    In order to be clear on the payment of a medical billing claim, the health care provider or medical biller must have complete knowledge of different insurance plans that insurance companies are offering, and the laws and regulations that preside over them. Large insurance companies can have up to 15 different plans contracted with one provider. When providers agree to accept an insurance company's plan, the contractual agreement includes many details including fee schedules which dictate what the insurance company will pay the provider for covered procedures and other rules such as timely filing guidelines.

    Providers typically charge more for services than what has been negotiated by the physician and the insurance company, so the expected payment from the insurance company for services is reduced. The amount that is paid by the insurance is known as an allowable amount. For example, although a psychiatrist may charge $80.00 for a medication management session, the insurance may only allow $50.00, and so a $30.00 reduction (known as a "provider write off" or "contractual adjustment") would be assessed. After payment has been made, a provider will typically receive an Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA) along with the payment from the insurance company that outlines these transactions.

    The insurance payment is further reduced if the patient has a copay, deductible, or a coinsurance. If the patient in the previous example had a $5.00 copay, the physician would be paid $45.00 by the insurance company. The physician is then responsible for collecting the out-of-pocket expense from the patient. If the patient had a $500.00 deductible, the contracted amount of $50.00 would not be paid by the insurance company. Instead, this amount would be the patient's responsibility to pay, and subsequent charges would also be the patient's responsibility, until his expenses totaled $500.00. At that point, the deductible is met, and the insurance would issue payment for future services.

    A coinsurance is a percentage of the allowed amount that the patient must pay. It is most often applied to surgical and/or diagnostic procedures. Using the above example, a coinsurance of 20% would have the patient owing $10.00 and the insurance company owing $40.00.

    Steps have been taken in recent years to make the billing process clearer for patients. The Healthcare Financial Management Association (HFMA) unveiled a "Patient-Friendly Billing" project to help healthcare providers create more informative and simpler bills for patients. Additionally, as the Consumer-Driven Health movement gains momentum, payers and providers are exploring new ways to integrate patients into the billing process in a clearer, more straightforward manner.


  6. Electronic billing
    A practice that has interactions with the patient must now under HIPAA (Health Insurance Portability and Accountability Act) send most billing claims for services via electronic means. Prior to actually performing service and billing a patient, the care provider may use software to check the eligibility of the patient for the intended services with the patient's insurance company. This process uses the same standards and technologies as an electronic claims transmission with small changes to the transmission format, this format is known specifically as X12-270 Health Care Eligibility & Benefit Inquiry transaction. A response to an eligibility request is returned by the payer through a direct electronic connection or more commonly their website. This is called an X12-271 "Health Care Eligibility & Benefit Response" transaction. Most practice management/EM software will automate this transmission, hiding the process from the user.

    This first transaction for a claim for services is known technically as X12-837 or ANSI-837. This contains a large amount of data regarding the provider interaction as well as reference information about the practice and the patient. Following that submission, the payer will respond with an X12-997, simply acknowledging that the claim's submission was received and that it was accepted for further processing. When the claim(s) are actually adjudicated by the payer, the payer will ultimately respond with a X12-835 transaction, which shows the line-items of the claim that will be paid or denied; if paid, the amount; and if denied, the reason.


  7. Billing process

    The medical billing process is a process that involves a health care provider and the insurance company (payer) pertaining to the payment of medical services rendered to the clients. The entire procedure involved in this is known as the billing cycle sometimes referred to as Revenue Cycle Management. Revenue Cycle Management involves managing claims, payment and billing. This can take anywhere from several days to several months to complete, and require several interactions before a resolution is reached. The relationship between a health care provider and insurance company is that of a vendor to a subcontractor. Health care providers are contracted with insurance companies to provide health care services. The interaction begins with the office visit: a physician or their staff will typically create or update the patient's medical record.

    After the doctor sees the patient, the diagnosis and procedure codes are assigned. These codes assist the insurance company in determining coverage and medical necessity of the services. Once the procedure and diagnosis codes are determined, the medical biller will transmit the claim to the insurance company (payer). This is usually done electronically by formatting the claim as an ANSI (American National Standards Institute) 837 file and using Electronic Data Interchange to submit the claim file to the payer directly or via a clearinghouse. Historically, claims were submitted using a paper form; in the case of professional (non-hospital) services Centers for Medicare and Medicaid Services. At time of writing, about 30% of medical claims get sent to payers using paper forms which are either manually entered or entered using automated recognition or OCR software.

    The insurance company (payer) processes the claims usually by medical claims examiners or medical claims adjusters. For higher dollar amount claims, the insurance company has medical directors review the claims and evaluate their validity for payment using rubrics (procedure) for patient eligibility, provider credentials, and medical necessity. Approved claims are reimbursed for a certain percentage of the billed services. These rates are pre-negotiated between the health care provider and the insurance company. Failed claims are denied or rejected and notice is sent to provider. Most commonly, denied or rejected claims are returned to providers in the form of Explanation of Benefits (EOB) or Electronic Remittance Advice.

    In case of the denial of the claim, the provider reconciles the claim with the original one, makes necessary rectifications and resubmits the claim.This exchange of claims and denials may be repeated multiple times until a claim is paid in full, or the provider relents and accepts an incomplete reimbursement.

    There is a difference between a “denied” and a “rejected” claim, although the terms are commonly interchanged. A denied claim refers to a claim that has been processed and the insurer has found it to be not payable. A denied claim can usually be corrected and/or appealed for reconsideration. Insurers have to tell you why they've denied your claim and they have to let you know how you can dispute their decisions. A rejected claim refers to a claim that has not been processed by the insurer due to a fatal error in the information provided. Common causes for a claim to reject include when personal information is inaccurate (i.e.: name and identification number do not match) or errors in information provided (i.e.: truncated procedure code, invalid diagnosis codes, etc.) A rejected claim has not been processed so it cannot be appealed. Instead, rejected claims need to be researched, corrected and resubmitted.


  8. For several decades, medical billing was done almost entirely on paper. However, with the advent of medical practice management software, also known as health information systems, it has become possible to efficiently manage large amounts of claims. Many software companies have arisen to provide medical billing software to this particularly lucrative segment of the market. Several companies also offer full portal solutions through their own web-interfaces, which negates the cost of individually licensed software packages. Due to the rapidly changing requirements by U.S. health insurance companies, several aspects of medical billing and medical office management have created the necessity for specialized training. Medical office personnel may obtain certification through various institutions who may provide a variety of specialized education and in some cases award a certification credential to reflect professional status.


  9. Medical billing is a payment practice within the United States health system. The process involves a healthcare provider submitting, following up on, and appealing claims with health insurance companies in order to receive payment for services rendered; such as testing, treatments, and procedures. The same process is used for most insurance companies, whether they are private companies or government sponsored programs: Medical coding reports what the diagnosis and treatment were, and prices are applied accordingly. Medical billers are encouraged, but not required by law, to become certified by taking an exam such as the CMRS (Certified Medical Reimbursement Specialist) Exam, RHIA (Registered Health Information Administrator) Exam and others. Certification schools are intended to provide a theoretical grounding for students entering the medical billing field. Some community colleges in the United States offer certificates, or even associate degrees, in the field. Those seeking advancement may be cross-trained in medical coding or transcription or auditing, and may earn a bachelor's or graduate degree in medical information science and technology.


  10. What is Medical Billing?
    Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider. Medical billing translates a healthcare service into a billing claim. The responsibility of the medical biller in a healthcare facility is to follow the claim to ensure the practice receives reimbursement for the work the providers perform. A knowledgeable biller can optimize revenue performance for the practice.

    Is Medical Coding the Same as Medical Billing?
    No. The main responsibility of a medical coder is to review clinical statements and assign standard codes using CPT® (Current Procedural Terminology), ICD-10-CM (10th revision from the International Classification of Diseases), and HCPCS ( Healthcare Common Procedure Coding System) Level II classification systems. Medical billers, on the other hand, process and follow up on claims sent to health insurance companies for reimbursement of services rendered by a healthcare provider. The medical coder and medical biller may be the same person or may work with each other to ensure invoices are paid properly. To better understand what a coding transaction looks like, read the article "What Does a Medical Coder Do?"

    What Do Medical Billers and Coders Do?
    Medical billing and coding specialists are largely responsible for making sure medical office revenue cycles run smoothly. When a service is performed, a medical coder assigns codes to the services rendered. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician's notes, laboratory and radiologic results, etc.

    Although a medical biller’s duties vary with the size of the work facility, the biller typically assembles all data concerning the bill. This can include charge entry, claims transmission, payment posting, insurance follow-up, and patient follow-up.

    Medical billers regularly communicate with physicians and other healthcare professionals to clarify diagnoses or to obtain additional information. The medical biller must understand how to read the medical record and, like the medical coder, be familiar with CPT®, HCPCS Level II and ICD-10-CM codes.


  11. Pharmacy2U is an online mail-order pharmacy located in the UK. The company was founded by pharmacist Daniel Lee in 1999. Pharmacy2U has been involved in piloting the electronic transfer of prescriptions in the UK.

    History

    Foundation
    Founder Daniel Lee worked for his family's pharmacy business until 1999, when he decided to form his own company. His father owned a chain of chemists shops in Leeds. He thought of the idea to found an Internet mail-order pharmacy in 1997 after a report by the NHS about its initiative to deliver prescriptions to patients more efficiently. Although at the time it was not legal to sell prescriptions by mail in the UK, Lee sold his apartment for £100,000 in order to put the money into the creation of Pharmacy2u.co.uk, basing his shipping out of his father's pharmacy business. The site went live in November 1999, and used a courier service. Julian Harrison from Andersen Consulting became a director in January 2000.

    Pharmacy2U became the UK's first online pharmacy. The British Medical Association expressed concern over the innovation, and the National Pharmaceutical Association resisted the move towards filling prescriptions online in 1999. UK health organizations persistently pushed back against online ordering in 1999 due to concerns over change in the medical industry's infrastructure. A few days after they first opened an inspection team arrived in order to scrutinize their business practices and structure. The result of the inspection was a positive recommendation to stay open, which lead to an amendment of the 1968 Medicines Act as well as the codes of ethics of the Royal Pharmaceutical Society in order to allow for the establishment of Internet-based pharmacies.

    2000s

    In June 2000 the company relaunched its website as the UK government allowed the transfer of prescriptions electronically. In August 2000 Pharmacy2U was one of the founding members of the European Association of Mail Service Pharmacies. In October 2000 the firm OnMedica invested £2 million into Pharmacy2U. By 2001 the website had about half a million pounds in sales.

    In November 2000 the company launched the first ever advertising campaign for an online pharmacy. In 2001 the company was used as a benchmark for price comparison for pharmaceuticals in the UK by the BBC. In 2001 the company was awarded a pilot program from the NHS for the electronic transfer of prescriptions. In 2001 Pharmacy2U also produced the UK's first mail order pharmacy catalogue. The company also provided non-prescription health and beauty products for sale.

    In 2001 Pharmacy2U backed an electronic transfer of prescription pilot where patients could request prescriptions electronically and receive a postal delivery instead of having to do an in-person pick-up. It was one of three companies chosen by the NHS to run the pilot program and trial, which covered prescriptions in Stockport and the South of England. It focused on the requesting and electronic prescribing of repeat prescriptions and their home delivery. Seventy general practice surgeries were involved, as well as partners EMIS Health, Hadley Healthcare, and the NorthWest Co-op in UK.

    In 2003 The Guardian stated that Pharmacy2U had organized the biggest change in the UK market in moving towards electronic prescriptions by "allowing patients' prescriptions to be delivered anywhere in the UK for no extra charge. Delivery required the signature of the patient or their named representative". By that year it had incorporated 142 surgeries into its program. In 2004 an evaluation of the technical models used in the English ETP pilots was undertaken by Bob Sugden and Rob Wilson, in which they stated that the pilots had been technically viable. Studies commissioned by Pharmacy2U revealed that one third of UK patients' prescriptions were not filled.

    In 2007, the company was presented with the Yorkshire Post's Small Business of the Year Award.

    In 2008 the company had £12 million in sales. At this point it served 250 general practice surgeries and provided white label pharmacy ecommerce systems for supermarkets. In 2012 Andy Hornby became chairman of the board for the company.  That year the company also launched an automated phone prescription service allowing patients to request repeat prescriptions by telephone.

    2010s
    In October 2015 the company was fined £130,000 for selling patients' personal data to international scammers. The Information Commissioner's Office found that the company had sold patients' names and addresses without permission. They were not accused of passing on medical information. The buyers, including a health supplements company, were warned for misleading advertising and unverified health claims. An Australian lottery company was said to have deliberately targeted elderly and vulnerable individuals.

    In December 2015 the company stopped providing medication for several weeks due to a failure of their automated dispensing system.

    In January 2016, a study on adherence research, co-funded by the firm, concluded that "telephone intervention, led by a pharmacist and tailored to the individuals’ needs, can significantly improve medication adherence in patients with long-term conditions, using a mail-order pharmacy. Further work is needed to confirm a trend towards improved clinical outcome."

    According to the statistics for March 2016 from the NHS Business Services Authority, Pharmacy2U was the largest NHS contracted Pharmacy.

    In July 2016, Pharmacy2U announced a merger with Chemist Direct.

    in 2018 the company was dispensing 300,000 items a month.

    The company was in a legal dispute in late 2018 over the rights of the contact details of members of the National Pharmacy Association. The presiding judge expressed concerns over the company's ability to "pick off" individual members


  12. UK consumers

    In the UK more than 2 million people buy drugs regularly over the Internet from online pharmacies; some are legitimate but others have "dangerous practices" that could endanger children. In 2008, the RPSGB (Royal Pharmaceutical Society of Great Britain) introduced a green cross logo to help identify accredited online pharmacies (from 2010 the internet pharmacy logo scheme is run by the GPhC (General Pharmaceutical Council)).

    European registered pharmacists have reciprocal agreements allowing them to practice in the UK by getting registered with the General Pharmaceutical Council.

    The first internet pharmacy in the UK was Pharmacy2U, which started operating in 1999. The UK is a frontline leader in internet pharmacy since a change to NHS pharmacy regulations in 2005 that made it legal for pharmacies to fill NHS prescriptions over the internet. Drugs supplied in this way tend to be medicines which doctors refuse to prescribe for patients, or would charge a private prescription fee, as all patients treated under the National Health Service pay either a flat price or nothing for prescribed medicine (except for medicine classed as lifestyle medicine, e.g. anti-malarials for travel), and medical equipment. Since July 2015 the Medicines and Products Regulatory Agency (MHRA) has required online sellers of medicines to adopt an EU wide logo and maintain an entry in the MHRA medicines sellers registry.

    In the UK, online pharmacies often link up with online clinic doctors. Doctors carry out online consultations and issue prescriptions. The company employing the doctors must be registered with the Care Quality Commission. Online clinics only prescribe a limited number of medicines and do not replace regular doctors working from surgeries. There are various ways the doctors carry out the online consultations; sometimes it is done almost entirely by questionnaire. Customers usually pay one fee which includes the price of the consultation, prescription and the price of the medicine.

    As of April 2016, there were 46 registered online pharmacies in England. In April 2017 the Care Quality Commission suspended the registration of Doctor Matt Ltd – trading as theonlinesurgery.co.uk because of inadequate medical assessment of prescription requests. Six have been warned after inspections.

    Pharmacy2U claimed in June 2018 that online dispensing could save the NHS up to £400 million a year, a claim disputed by other pharmacy organisations.


  13. Indian consumers

    Online pharmacies in India have significantly increased due to growing E-commerce in India and little regulation of the industry.

    There is "no regulatory control over drug advertisements on television or the Internet".

    Technology can help in meeting the healthcare objective of India. Indian government is planning to spend Rs 500 crore on computer literacy project for 50 lakh people over a period of 3 years. This would help Indian citizens to access government services in the fields of e-education, e-health and e-governance. Healthcare providers in India are also expected to spend $1.1 billion on IT products and services in 2014.

    Legal status in India

    There is no specific law to deal with online pharmacies in India but multiple laws govern online pharmacies in an indirect manner. The Drugs and Cosmetics Act, 1940, and the Drugs and Cosmetics Rules, 1945, have guidelines on the sale of Schedule H and Schedule X drugs. These can be sold only on prescription and there are specific rules, including for labelling and bar coding.

    It appears that electronic prescriptions should be valid especially in the light of the Pharmacy Practise Regulations of 2015 declared by Pharmacy Council of India in January 2015. In these regulations, “Prescription” is defined by regulation 2 (j) ‘means a written or electronic direction from a Registered Medical Practitioner.’ On basis of existing regulations it appears that a scanned copy of prescription will be perfectly considered as a valid prescription. However, whether such electronic prescriptions can be used to buy medicine from online pharmacies has been questioned.

    The Maharashtra Food and Drugs Administration (FDA) raided 27 online pharmacies located in Mumbai, Thane and Pune and seized drugs worth Rs. 2 Crore.

    Pakistani consumers in 2015, the Drug Regulatory Authority of Pakistan Act passed for the registration of homeopathic, herbal, unani, allopathic, and nutraceutical products. This has also implied that only registered retail pharmacies can sell such items, along with OTC and Prescription medication, to the public.

    The sale of all drugs in Pakistan is subject to the Drugs Act of 1976.


  14. Bulgarian consumers

    All Bulgarian online pharmacies must be registered with the Bulgarian drug agency (BDA). BDA controls the trade with medicines and makes analysis when doubting the quality and safety of drugs. A special BDA logo and a certificate for registration of pharmacy proves the accreditation and the legitimacy of the store. When clicking on the logo, the consumer will be taken to the official page of the Bulgarian drug agency. The web page must deliver information about the pharmacy's name, address, registration number and its manager.

    Canadian online pharmacies selling to United States customers

    Buying prescription drugs from even the most well respected internet pharmacies in Canada often results in a prescription filled from drugs sourced not from Canada but rather Caribbean nations or from eastern Europe. The Canadian online pharmacy that sells the drugs offers a Canadian price but buys at a still cheaper rate from third parties overseas. This has led to problems with prescriptions being filled with counterfeit drugs, which sometimes have no activity whatsoever. Some pharmacists have exited this business because of the ethical problems involved, and some less-established Internet sites may be knowingly selling fake drugs. In 2014, the largest online Canada drug retailer was forbidden by Health Canada from selling wholesale drug. Of the three primary entrepreneurs of online Canadian drugs sold to the United States, one is in jail, one exited the industry entirely, and the third is under investigation for criminal wrongdoing. The same errors have occurred in US pharmacies, notably CVS. For more about this see "Canada Drugs' history and closure".


  15. Mail fraud
    All online pharmacies sell through the internet but must ship the product usually via the mail. The selling of many class (schedule) drugs without a valid prescription (also called Rx-only drugs or legend drugs) is illegal and companies shipping them by mail can be prosecuted for mail fraud (Postal Inspection Service) as well as investigations and Federal charges by the DEA, IRS, Homeland Security, Food and Drug Administration’s Office of Criminal Investigations, Department of Justice, INTERPOL, and the U.S. Immigration and Customs Enforcement (ICE), and it is common practice for many agencies to jointly investigate alleged crimes


  16. Overseas online pharmacies and U.S. law

    Legality and risks of purchasing drugs online depend on the specific kind and amount of drug being purchased.

    The FDA believes that many selling illegal pharmaceutical products without prescriptions are controlled by organised criminal networks. In 2014, The U.S. FDA, in partnership with other federal and international agencies and technology companies like Google, took action against websites, some based in India, that were selling drugs to U.S. consumers. Mail Order pharmacies are regulated by the federal laws of the US  and hundreds of them operate legally in the US. ICANN and U.S. regulatory authorities are also engaged in hot debate about blocking and seizing of illegal online pharmacies websites that ICANN is not very much interested in doing these days.

    Enforcement

    It is illegal to purchase controlled substances from an overseas pharmacy. A person purchasing a controlled substance from such a pharmacy may be violating several federal laws that carry stiff penalties.

    Any package containing prescription drugs may be seized by US Customs and Border Protection. The package may be held and eventually returned to the sender if the addressee does not respond and provide proof that they are allowed to receive these drugs (e.g., a valid prescription). In practice, the number of packages containing prescription drugs sent to United States on a daily basis far exceeds CBP's capabilities to inspect them. In the past, packages often passed through customs even if they were not sent from Canada or otherwise didn't meet the requirements of section 844 of 21 USC. Until recently, about 5 percent of prescription drug packages sent from Canada were being seized.

    DEA and FDA generally do not target consumers unless drugs are imported in large quantities (suggesting intent to distribute) or represent a perceived danger to public health (opiates, amphetamines).

    Rarely, drug importation laws are enforced on the local level. For example, in June 2005 in Baton Rouge, Louisiana, a number of customers of online pharmacies were arrested by local law enforcement officers and charged with possession of a controlled substance without prescription.

    The act of importation of the controlled substance from overseas violates 21 USC, Section 952 (up to 5 years in prison and $250,000 fine for importation of non-narcotic Schedule III, IV, or V drugs; possibly more for narcotics and Schedule I and II drugs). The act of simple possession of a controlled substance without a valid prescription violates 21 USC, Section 844 (up to 1 year in prison and $1,000 fine). FDA does not recognize online prescriptions; for a prescription to be valid there must be a face-to-face relationship between the patient and the health-care professional prescribing the drug. What exactly constitutes a "face-to-face" relationship is considered by many online pharmacies to be a subjective definition that would allow them to operate as an adjunct to the patient's own physician if the patient submits medical records documenting a condition for which the requested medication is deemed appropriate for treatment. Sections 956 and 1301 provide exemptions for travelers who bring small quantities of controlled substances in or out of the country in person, but not by mail.

    Importation of an unapproved prescription drug (not necessarily a controlled substance) violates 21 USC, Section 301(aa), even for personal use. The Food, Drug, and Cosmetic Act does allow for the importation of drug products for unapproved new drugs for which there is no approved American version. However, this allowance does not allow for the importation of foreign-made versions of U.S. approved drugs.

    The law further specifies that enforcement should be focused on cases in which the importation by an individual poses a threat to public health, and discretion should be exercised to permit individuals to make such importations in circumstances in which the prescription drug or device imported does not appear to present an unreasonable risk to the individual.

    It is also illegal to import non-approved drugs (21 USC sections 331(d) and 355(a)); however, FDA policies suggest that, under certain circumstances, patients may be allowed to keep these drugs.

    Individual U.S. states may implement their own laws regulating importation, possession, and trafficking in prescription drugs and/or controlled substances.

    For several years, the states of Nevada, Minnesota, Illinois and Wisconsin have run official state programs to help their residents order lower-cost drugs from abroad to save money.


  17. U.S. consumers

    An attraction of online pharmacies is drug prices. Shoppers can sometimes obtain 50 to 80 percent or more savings on U.S. prices at foreign pharmacies. The Washington Post reported that "...millions of Americans have turned to Mexico and other countries in search of bargain drugs...U.S. Customs estimates 10 million U.S. citizens bring in medications at land borders each year. An additional 2 million packages of pharmaceuticals arrive annually by international mail from Thailand, India, South Africa and other points. Still more packages come from online pharmacies in Canada." According to a Wall Street Journal/Harris Online poll in 2006, 80 percent of Americans favor importing drugs from Canada and other countries. Factors independently associated with importation by U.S. residents are age greater than 45 years, south or west region of residence, Hispanic ethnicity, college education, poor or near poor poverty status, lack of U.S. citizenship, travel to developing countries, lack of health insurance, high family out-of-pocket medical costs, trouble finding a healthcare provider, fair or poor self-reported health status, filling a prescription on the Internet, and using online chat groups to learn about health. President Obama’s budget supports a plan to allow people to buy cheaper drugs from other countries. A 2016 study suggested that providing health insurance coverage may significantly reduce personal prescription drug importation and the subsequent risk of exposure to counterfeit, adulterated, and substandard medications. Further, health insurance coverage is likely to be particularly effective at reducing importation among persons who were Hispanic; born in Latin America, Russia, or Europe; and traveled to developing countries. A report in the journal Clinical Therapeutics found that U.S. consumers face a risk of getting counterfeit drugs because of the rising Internet sales of drugs, with worldwide counterfeit drug sales, offline and online, projected to reach $75 billion by 2010.

    Independent research published by the National Bureau of Economic Research demonstrates that online pharmacies, U.S. and foreign, verified by certain credentialing entities, sell genuine medication and require a prescription. In that study, all tested prescription drug orders were found to be authentic when ordered from online pharmacies, international and U.S.-only, approved by PharmacyChecker.com, as well as U.S. online pharmacies approved by the National Association of Boards of Pharmacy (NABP) Verified Internet Pharmacy Practice Sites (VIPPS) program or LegitScript, and Canadian-based online pharmacies approved by the Canadian International Pharmacy Association. Nine percent of tested products ordered from non-credentialed online pharmacies were counterfeit.

    There are two verification programs for online pharmacies that are recognized by the National Association of Boards of Pharmacy (NABP). One is VIPPS, which is operated by the NABP and was created in 1999. The Food and Drug Administration refers Internet users interested in using an online pharmacy to the VIPPS program. The other is LegitScript, which as of September 2010 had approved over 340 Internet pharmacies as legitimate and identified over 47,000 "rogue" Internet pharmacies. Canadian and all non-U.S. online pharmacies that sell prescription medication to Americans, regardless of credentials, are not eligible for approval in the VIPPS and LegitScript programs.


  18. Discussion

    Legitimate mail-order pharmacies are somewhat similar to community pharmacies; one primary difference is the method by which the medications are requested and received. Some customers consider this to be more convenient than traveling to a community drugstore, in the same way as ordering goods online rather than going to a shop.

    While many internet pharmacies sell prescription drugs only with a prescription, some do not require a pre-written prescription. In some countries, this is because prescriptions are not required. Some customers order drugs from such pharmacies to avoid the cost and inconvenience of visiting a doctor or to obtain medications their doctors were unwilling to prescribe. People living in the United States and other countries where prescription medications are very expensive may turn to online pharmacies to save money. Many of the reputable websites employ their own in-house physicians to review the medication request and write a prescription accordingly. Some websites offer medications without a prescription or a doctor review. This practice has been criticized as potentially dangerous, especially by those who feel that only doctors can reliably assess contraindications, risk/benefit ratios, and the suitability of a medication for a specific individual. Pharmacies offering medication without requiring a prescription and doctor review or supervision are sometimes fraudulent and may supply counterfeit—and ineffective and possibly dangerous—medicines.

    International consumers

    International consumers sometimes purchase drugs online from online pharmacies in their own countries, or those located in other countries. Some of these pharmacies require prescriptions, while others do not. Of those that do not require prescriptions, some ask the customer to fill in a health questionnaire with their order. Many drugs available at legitimate online pharmacies are produced by well-known manufacturers such as Pfizer, Wyeth, Roche, and generic drugmakers Cipla and Ranbaxy of India and Teva Pharmaceutical Industries of Israel. However, it remains difficult for a patient to ascertain whether an online pharmacy is legitimate. Medicines obtained from rogue online pharmacies come with no guarantees with regard to their identity, history and source. A study in three cities in the Netherlands found that over 60% of the consumed sildenafil was obtained from illegal sources.


  19. Home delivery

    Conventional stationary pharmacies usually have controlled drug distribution systems from the manufacturer. Validation and good distribution practices are followed. Home delivery of pharmaceuticals can be a desirable convenience but sometimes there can be problems with uncontrolled distribution.

    The shipment of drugs through the mail and parcel post is sometimes a concern for temperature-sensitive pharmaceuticals. Uncontrolled shipping conditions can include high and low temperatures outside of the listed storage conditions for a drug. For example, the US FDA found the temperature in a mail box in the sun could reach 136 °F (58 °C) while the ambient air temperature was 101 °F (38 °C)

    Shipment by express mail and couriers reduces transit time and often involves delivery to the door, rather than a mail box. The use of insulated shipping containers also helps control drug temperatures, reducing risks to drug safety and efficacy.

    Risks and concerns

    Illegal or unethical pharmacies sometimes send outdated, substituted, or counterfeit medications
    Sometimes an online pharmacy may not be located in the country that is claimed. For example, one study of drug shipments claiming to be from Canada revealed many actually originated in several different countries and were often bogus medications
    Minors or children can order controlled substances without adult supervision.
    Other concerns include potential lack of confidentiality, improper packaging, inability to check for drug interactions, and several other issues.


  20. An online pharmacy, Internet pharmacy, or mail-order pharmacy is a pharmacy that operates over the Internet and sends the orders to customers through the mail or shipping companies.

    Online pharmacies might include:

    Pharmacy benefit manager – A large administrator of corporate prescription drug plans

    Legitimate Internet pharmacy in the same country as the person ordering.

    Legitimate Internet pharmacy in a different country than the person ordering. This pharmacy usually is licensed by its home country and follows those regulations, not those of the international orders.

    Illegal or unethical internet pharmacy. The web page for an illegal pharmacy may contain lies about its home country, procedures, or certifications. The "pharmacy" may send outdated (expired shelf life) or counterfeit medications and may not follow normal procedural safeguards.


  21. The “Why” Portion

    Many prescriptions that you write will be for “as needed” medications. This is known as a “PRN” (from the Latin pro re nata, meaning as circumstances may require). For example, you may write for ibuprofen every 4 hours “as needed.” What is commonly missed is the “reason.” Why would it be needed? You need to add this to the prescription. You should write “PRN headache” or “PRN pain” so that the patient knows when to take it.

    How Much

    The “how much” instruction tells the pharmacist how many pills should be dispensed, or how many bottles, or how many inhalers. This number is typically written after “Disp #.” I highly recommend that you spell out the number after the # sign, though this is not required. For example: I would write “Disp #30 (thirty).” This prevents someone from tampering with the prescription and adding an extra 0 after 30, turning 30 into 300.

    Refills

    The last instruction on the prescription informs the pharmacist how many times the patient will be allowed to use the same exact prescription, i.e. how many refills are allowed. For example, let’s take refills for oral contraceptives for women. A physician may prescribe 1 pack of an oral contraceptive with 11 refills, which would last the patient a full year. This is convenient for both the patient and physician for any medications that will be used long term.


  22. Strength

    After you write the medication name, you need to tell the pharmacist the desired strength. Many, if not most, medications come in multiple strengths. You need to write which one you want. Often times, the exact strength you want is not available, so the pharmacist will substitute an appropriate alternative for you. For example, if you write prednisone (a corticosteroid) 50 mg, and the pharmacy only carries 10 mg tablets, the pharmacist will dispense the 10 mg tabs and adjust the amount the patient should take by a multiple of 5.

    Amount

    Using my previous example for prednisone, the original prescription was for 50 mg tabs. The prescriber would have written “prednisone 50 mg, one tab….” (I’ll leave out the rest until we get there). The “one tab” is the amount of the specific medication and strength to take. Again using my previous example, the instructions would be rewritten “prednisone 10 mg, five tabs….” You can see that “one tab” was changed to “five”. Pharmacists make these changes all the time, often without any input needed from the physician.

    Route

    Up until this point, we have been using plain English for the prescriptions. The route is the first opportunity we have to start using English or Latin abbreviations. A NOTE: it is often suggested that to help reduce the number of medication errors, prescription writing should be 100% English, with no Latin abbreviations. I will show you both and let you decide. There are several routes by which a medication can be taken: By Mouth (PO), Per Rectum (PR), Sublingually (SL), Intramuscularly (IM), Intravenously (IV), Subcutaneously (SQ)

    As you can see, the abbreviations are either from Latin roots like PO – per os – or just common combination of letters from the English word. Unfortunately when you are in a hurry and scribbling these prescriptions, (there is a truth behind never being able to read a physician’s hand writing) many of these abbreviations can look similar. For example, intranasal is often abbreviated “IN,” which, when you are in a hurry, can be mistaken for “IM” or “IV.” Check this out:

    Common Route Abbreviations:

    • PO (by mouth)
    • PR (per rectum)
    • IM (intramuscular)
    • IV (intravenous)
    • ID (intradermal)
    • IN (intranasal)
    • TP (topical)
    • SL (sublingual)
    • BUCC (buccal)
    • IP (intraperitoneal)
    Frequency

    The frequency is simply how often you want the prescription to be taken. This can be anywhere from once a day, once a night, twice a day or even once every other week. Many frequencies start with the letter “q.” Q if from the Latin word quaque which means once. So it used to be that if you wanted a medication to be taken once daily, you would write QD, for “once daily” (“d” is from “die,” the Latin word for day). However, to help reduce medication errors, QD and QOD (every other day) are on the JCAHO “do not use” list. Instead you need to write “daily” or “every other day.”

    Common Frequencies Abbreviations:

    • daily (no abbreviation)
    • every other day (no abbreviation)
    • BID/b.i.d. (Twice a Day)
    • TID/t.id. (Three Times a Day)
    • QID/q.i.d. (Four Times a Day)
    • QHS (Every Bedtime)
    • Q4h (Every 4 hours)
    • Q4-6h (Every 4 to 6 hours)
    • QWK (Every Week)

  23. Prescriptions

    A prescription is an order that is written by you, the physician (or medical student with signature by a physician) to tell the pharmacist what medication you want your patient to take. The basic format of a prescription includes the patient’s name and another patient identifier, usually the date of birth. It also includes the meat of the prescription, which contains the medication and strength, the amount to be taken, the route by which it is to be taken and the frequency. Often times, for “as needed” medications, there is a symptom included for when it is to be taken. The prescriber also writes how much should be given, and how many refills. Once completed with a signature and any other physician identifiers like NPI number or DEA number, the prescription is taken to the pharmacist who interprets what is written and prepares the medication for the patient. Let’s break it down.

    Patient Identifiers

    According to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) national patient safety goals, at least two patient identifiers should be used in various clinical situations. While prescription writing is not specifically listed, medication administration is. I think prescription writing should be considered in this category as well. The two most common patient identifiers are full name and date of birth. These are the FIRST things to write on a prescription. This way you don’t write a signed prescription without a patient name on it that accidentally falls out of your white coat and onto the floor in the cafeteria.

    Drug/Medication

    This is an easy one. This is the medication you want to prescribe. It generally does not matter if you write the generic or the brand name here, unless you specifically want to prescribe the brand name. Remember, if you do want the brand name, you specifically need to tell the pharmacist – “no generics.” There are several reasons why you would want to do this, but we won’t get into that here. On the prescription pad, there is a small box which can be checked to indicate “brand name only” or “no generics


  24. Prescription writing is something that I used to worry so much about in my 3rd year of medical school. I probably killed a whole tree tearing up prescriptions that were wrong. Why did I worry so much about it? Prescription writing was not covered very well at my medical school. And with the amount of material that needs to be covered in those 4 years, I’m sure writing prescriptions is not that well covered at any medical school. Maybe that’s one of the reasons there are so many medication errors in medicine. Look at some of these commonly quoted statistics:

    • Medication errors occur in approximately 1 in every 5 doses given in hospitals.
    • One error occurs per patient per day.
    • 1.3 million people are injured and approximately 7000 deaths occur each year in the U.S. from medication-related errors
    • Drug-related morbidity and mortality is estimated to cost $177 billion in the U.S.

    While these are just estimates from various studies and statistical models, the numbers are staggering. If there are 800,000 physicians in the United States, each physician accounts for $221,250! Do you still wonder why malpractice insurance is so expensive?

    Hopefully if you are reading this, you are interested in NOT making mistakes. Even though I don’t think I caused any major harm to any of my patients with prescription errors, I wish that I had read something like this when I first started writing prescriptions when I was in my 3rd year of medical school.


  25. Why split tablets?

    Use of medications for chronic illnesses, such as hypertension, diabetes, or high cholesterol - all common U.S. conditions - can often run into the thousands of dollars per year. Rising healthcare costs often force consumers to try innovative ways to save a portion of their healthcare dollar. Splitting tablets in half is a practice that some patients, employers, healthcare providers, and even health insurance and managed care companies are now recommending. For example, United Healthcare has instituted the “Half Tablet Program” to guide their members into cost-savings. Tablet splitting under the direction of a healthcare provider can be safe and save you money, too.

    Patients should always check with their doctor or pharmacist first to make sure splitting their pill is a safe and economical choice.
    Splitting tablets - actually cutting them in half - may save some patients up to 50 percent of their cost of the medication. In fact, in a 2009 survey, more than half of surveyed Americans said they would consider splitting their prescription pills to save money if their doctor said it would not be detrimental to their health.

    But it’s important to note not all pills can be split safely, and not all medical experts agree that it is a good practice - including the American Medical Association and the American Pharmacists Association. Some drug companies also oppose pill splitting. However, splitting tablets may help consumers comply with their expensive medication regimens and in turn have better health outcomes.

    How does pill splitting work?

    Pill splitting allows the consumer to buy two doses of medicine for the cost of one dose - the equivalent to getting two months of medications for the price of one.

    For example: you take 10 milligram (mg) of a cholesterol-lowering drug every day, but the 20 mg tablet costs just about the same. If you buy the 20 mg tablets, cut them in half, and then take only one-half (now equal to 10 mg), you can double your buying power.

    Many pills that can be safely split have a “score”, a line down the middle of the pill, that allows for easier splitting. Be aware that not all tablets that are scored are safe to split in half. On the other hand, some tablets that are not scored can be safely cut in half. For precise splitting, consumers should buy a pill splitter at the pharmacy. They work best for round pills that are scored, but may not work for oddly shaped pills.

    The U.S. Food and Drug Administration (FDA) has put out a list of “Best Practices for Tablet Splitting”. The main points are summarized here:

    FDA-approved tablets that can be safely split will be printed in the “HOW SUPPLIED” section of the professional label insert and in the patient package insert. Also, the tablet will be scored with a mark indicating where to split it.
    If this information is not in the label, the FDA has not evaluated the tablet to ensure the two halves would be equivalent when split. The FDA suggests patients talk to their healthcare provider about whether to split pills that do not include this labeled information.

    Only split pills as you need them and take the split halves before splitting more tablets. Heat, humidity, or moisture content can affect the integrity of the medication; avoid leaving medication in steamy bathrooms or hot cars.
    Discuss with your doctor or pharmacist if you need to use a tablet splitter to cut your pills in half; pill splitters are inexpensive and can be found at most pharmacies for under $10. Pill splitters may not be appropriate for oddly shaped tablets. Don’t use a knife or razor to cut tablets as this may splinter pills.

    If you switch between brand names of the same medication, or between brands and generics, check with your healthcare provider to be sure the new tablets can be safely split.

    Other important points

    If you and your doctor decide tablet splitting is a good choice for you, don’t forget to split your medications before taking them; doing so could result in a doubling of your dose, and possible unintended side effects.

    If you have health insurance, check with your plan to see if they offer a formal program for tablet splitting. It might save you copay dollars. Typically, your doctor would write a prescription for double the strength of your medicine, but half of the monthly quantity. Your health plan might even send you a free tablet cutter.

    Some medications are not safe to split


    Examples include:

    Enteric-coated tablets, extended-release (ER or XR), sustained-release (SR), or timed-released medications should not be split. These medications are either coated to protect your stomach or have a built-in release mechanism to allow the medication to work longer. If you split or crush it, the medication may release all at once and cause an excessive dose with side effects that may be dangerous.
    Oddly shaped pills, most capsules
    Chemotherapy drugs
    Oral contraceptive pills
    Blood thinners, like warfarin or Coumadin
    Medications used for seizure control
    Combination tablets that contain two or more medicines but the strengths of one of the medications changes from one tablet size to the next, for example - irbesartan/hydrochlorothiazide (Avalide) or sitagliptin/metformin (Janumet). Check with your healthcare provider before you split any combination drug in half.

    Medications that can usually be split in half

    Amlodipine (Norvas)
    Aripiprazole (Abilify)
    Atorvastatin (Lipitor)
    Candesartan (Atacand)
    Citalopram (Celexa)
    Clonazepam (Klonopin)
    Doxazosin (Cardura)
    Escitalopram (Lexapro)
    Irbesartan (Avapro)
    Levothyroxine (Synthroid)
    Lisinopril (Zestril)
    Lovastatin (Mevacor)
    Losartan (Cozaar)
    Metformin (Glucophage)
    Metoprolol (Toprol)
    Moexipril (Univasc)
    Nefazodone (Serzone)
    Olanzapine (Zyprexa)
    Olmesartan medoxomil (Benicar)
    Paroxetine (Paxil, Pexeva)
    Perindopril (Aceon)
    Pioglitazone (Actos)
    Pravastatin (Pravachol)
    Quinapril (Accupril)
    Rosuvastatin (Crestor)
    Sertraline (Zoloft)
    Sildenafil (Viagra)
    Simvastatin (Zocor)
    Tadalafil (Cialis)
    Trandolapril (Mavik)
    Valsartan (Diovan)
    Vardenafil (Levitra)

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