Note To ePrescribing Customers – Appropriate/Inappropriate Use of Note to Pharmacy Field

Clinical Alert: Use of Note to Pharmacy Field

We are passing along this information from Surescripts® to our valued customers.

The National Council for Prescription Drug Programs (NCPDP) SCRIPT version 10.6 allows the transmission of a free-text Notes to Pharmacy field allowing prescribers to communicate additional non-codified information related to, but not part of, the prescription. In many cases, the free-text Notes field serves as an opportunity for prescribers to enter anything they feel is pertinent to the prescription, but which is often inappropriate. The receipt of inappropriate Notes can cause ambiguity and confusion that may result in pharmacy workflow disruptions, physician callbacks for clarification, and/or potential patient safety risks.

Symptoms: Inappropriate use of the Notes field includes information that already has a structured and codified field within the e-prescription message. The most concerning inappropriate use of this field is for patient directions, either supplemental or conflicting. This can lead to critical information not being conveyed to the patient.

Examples of inappropriate Notes content include:

[table id=1 /]

The Notes field should only include information to the pharmacist that does not already have structured fields designated for such information, so long as it does not conflict with information sent in other structured fields.

Examples of appropriate Notes content include:

[table id=2 /]


Below are the Surescripts® application certification requirements (ACR) that address appropriate use of the Notes field:

On a New Rx, the notes going into the message shall be labeled as “Notes to Pharmacist” or something similar on the user screen. It shall be clear that data passed in the character Notes field will not be shared with the patient. Prescription information that has a designated, standardized data field within the NCPDP script standard shall not be entered into the “Notes to Pharmacist” field. Some examples: SIG, Effective Date, Drug Name, Strength, or Quantity.

In order to optimize workflow efficiency and improve patient care and safety, please ensure your systems and users adopt and adhere to the guidelines explained above.

For Assistance:

If you have further questions or require assistance, please contact AZCOMP Technical Support, or McKesson Technical Support and your questions will be directed to the proper resource.

Five Facts about ICD-10 from CMS

quick fix icd-10 conversion team cartoon

The Centers for Medicare & Medicaid Services (CMS) recently talked with providers to identify common misperceptions about the transition to ICD-10 in order to help dispel some of the myths surrounding ICD-10.  Some of the most common questions and concerns about ICD-10 are covered in these five facts written by CMS.

The Five Facts about ICD-10 & CMS comments about them

1. The ICD-10 transition date is October 1, 2015.

The government, payers, and large providers alike have made a substantial investment in ICD-10.  This cost will rise if the transition is delayed, and further ICD-10 delays will lead to an unnecessary rise in health care costs.  Get ready now for ICD-10.

2. You don’t have to use 68,000 codes.

Your practice does not use all 13,000 diagnosis codes available in ICD-9.  Nor will it be required to use the 68,000 codes that ICD-10 offers.  As you do now, your practice will use a very small subset of the codes.

3. You will use a similar process to look up ICD-10 codes that you use with ICD-9.

Increasing the number of diagnosis codes does not necessarily make ICD-10 harder to use.  As with ICD-9, an alphabetic index and electronic tools are available to help you with code selection.

4. Outpatient and office procedure codes aren’t changing.

The transition to ICD-10 for diagnosis coding and inpatient procedure coding does not affect the use of CPT for outpatient and office coding.  Your practice will continue to use CPT.

5. All Medicare fee-for-service providers have the opportunity to conduct testing with CMS before the ICD-10 transition.

Your practice or clearinghouse can conduct acknowledgement testing at any time with your Medicare Administrative Contractor (MAC).  Testing will ensure you can submit claims with ICD-10 codes.  During a special “acknowledgment testing” week to be held on June 2015, you will have access to real-time help desk support.  Contact your MAC for details about testing plans and opportunities.

What this means for smaller independent practices (from our perspective)

First – if you feel you aren’t prepared, there is no time like today to get started.

What do you need to do to get prepared?  That answer is different for each different practice, but we have some resources available for you.  Use the ones that fit best with where you are at.

ICD-10 Planning Tools

ICD-10 Webinar Series – A few months back we hosted a series of ICD-10 webinars.  You can access the recordings now by clicking here.  In these 4 short webinars (each recording is between 30 to 45 minutes) we provide a lot of information to help with planning, to help you learn how to use the ICD-10 tools that are built into Medisoft v20/v19 and Lytec 2015/2014, how to conduct testing with your clearinghouse, and give other tips on how to become ICD-10 ready.

Quick ICD-10 Planning Checklist – This 1 page (front and back) checklist summarizes in simple terms what you need to consider for your practice to get ICD-10 ready.

ICD-10 Impact Summary – This 1 page (front side only) info sheet summarizes how ICD-10 might impact different aspects of your practice to help you understand what changes you might need to make. – They have some videos you can watch, a “Build Your Action Plan” tool you can use and many other articles and other resources.

Second – you need to upgrade to the ICD-10 ready version of your software.

Your software is not ICD-10 ready if you are not on Medisoft v20/v19, or Lytec 2015/2014.  Medisoft v18 or any other earlier model is not ICD-10 ready.  Lytec 2013 or any other earlier model is not ICD-10 ready.

Call us today at (888) 799-4777 to get your ICD-10 ready software.

Third – consider additional software solutions to help make the transition easier.

In addition to upgrading to Medisoft v20 or Lytec 2015, there are additional tools that can help make things easier.  Fact number 3 above provided by CMS states that electronic tools are available to help you with code selection.  Here are the tools that we have to offer.

Codes on Disk

If your time is valuable then you are going to truly appreciate this simple tool.  Import the latest CPT-4, ICD-10, and HCPCS codes for your specialty into Medisoft or Lytec to assist you with implementing the standard code set requirement for HIPAA.  Save yourself hours of manual labor entering all those procedure and diagnosis codes.  This tool can be used by existing Lytec and Medisoft users alike.  It will not erase your existing codes.

Encoder Pro

Encoder pro enables users to simultaneously search across ICD-10, CPT, and HCPCS codes to get integrated search results, code details, and descriptions.  This will save so much time compared to searching a physical code book by hand.  If you have Google or Bing at your fingertips, would you ever go pick up a phone book or encyclopedia or dictionary?  Take advantage of Encoder Pro the way you use Google to find things out.


Has your practice implemented an EMR yet?  If you are not using EMR yet, let ICD-10 be another reason to consider it.

How can EMR help with ICD-10?  The short answer is that we cover 5 ways an EMR can help make the transition to ICD-10 easier in our webinar series mentioned above.  Feel free to watch the webinar recordings.

Still not really a direct answer, but here are two questions to consider to get you started thinking about it.

Question 1: What is your paper superbill going to look like with the expanded list of codes you will use in your practice?

Question 2: With an increased need for documentation, how are you going to retrain yourself or your staff to be better at documentation?

With the transition to ICD-10, even though you won’t need to use all 68,000 codes, you will definitely see an increase in the number of codes you are using on a regular basis.  This could significantly increase the size of your superbill.  If you are seeing patients with a four or eight page superbill, how fun will that be to manage?

By implementing an EMR, you will make the switch to an electronic superbill which will be so much better for managing all those codes.  Additionally, the documentation needed with your ICD-10 claims will be taken care of for you while using the EMR program.

There are several other ways an EMR can help with ICD-10, which are covered in our webinar replay you can watch.  And of course EMR helps in many other aspects with amazing tools like e-prescribing, lab-interfaces, eliminating paper charts and helping to improve patient care to name just a few.  To learn more about our Medisoft and Lytec EMR options or to schedule a demo, just give us a call!

Lastly – practice using ICD-10 codes starting ASAP!

Practice!  Practice!  Practice!

Even if you have all of the tools that you need, if you wait until October 1 to start using everything, then it will be a rough transition.  If you haven’t worked out your own kinks, then you could see significant delays in getting your claims paid and you will be frustrated with the process.  Don’t do that to yourself.  You can start practicing today!

Here are a couple tips to help you start practicing.

Our second webinar recording shows you how to put your software (either Lytec or Medisoft) into “testing mode” so that you can submit test claims.  In our third webinar, we outline how you can test your ICD-10 claims with your clearinghouse.  We provide specific information from Relay Health because that is our preferred clearinghouse, but we give you the info you need so you can enquire with your own.

There is also a feature in your ICD-10 version of the program that allows you to just start coding everything in ICD-10 right now, but your claims will still be submitted in ICD-9 right up until September 30th!  In the program, you can set a date for when to start submitting your ICD-10 claims.  Set that date right now so you don’t need to worry about making any changes on the morning of October 1.  

Doing all this will allow you to practice coding in ICD-10 now and so that you and your staff can get comfortable with the changes, but without the added stress of potentially delayed payments.

That’s it for now.

If you’ve been working on getting ICD-10 ready at your practice – feel free to share your successes or your failures with the community so we can learn from each other.  Share with us in the comments below!

REMINDER: Final Surescripts Compliance Deadline

This is a reminder of the Surescripts 10.6 Sunset Policy for Routing and Medication History

If you are currently using an older version of Practice Partner, Medisoft Clinical or Lytec MD, and if you plan to continue to send Routing (New e-prescriptions and Refill Requests), Medication History, or Eligibility transactions, you have until June 30th, 2015 to upgrade to an EMR that is compliant with the Surescripts 10.6 protocol.

The compliant versions of EMR that we have available for you are Practice Partner v11.0, Medisoft Clinical v19 SP1, and Lytec MD 2014 SP1.  No previous versions of Practice Partner, Medisoft Clinical or Lytec MD are/will be compliant with the Surescripts requirement.

The Surescripts 10.6 Protocol

The Surescripts 10.6 Sunset Policy for Routing and Medication History is that Surescripts will reject all pre 10.6 or 4010 transactions starting on July 1, 2015.  Users of Medisoft Clinical, Lytec MD and Practice Partner EMR systems have until June 30th, 2015 to upgrade to one of the compliant EMR versions.

Reminder About ICD-10

In addition to the Surescripts requirement, ICD-10 is still scheduled to be implemented in October 1, 2015.  Practices using older versions of Practice Partner, Medisoft Clinical and Lytec MD will need to be on these same updated releases in order to be ready for ICD-10.  So even if you are not affected or using e-prescribing, but continuing to use older versions, those versions will not support ICD-10 coding on October 1, 2015.

Please contact us at (888) 799-4777 if you have any questions or need any help on this matter.

Disclaimer: AZCOMP Technologies, Inc, (AZCOMP) is providing this material as an informational reference for healthcare providers. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of posting, the Medicare/Medicaid programs are constantly changing, and it is the sole responsibility of each provider to remain abreast of  program requirements by consulting the authorities and directly from their the source 


Every Practice Should Be Doing This…

Every practice should be doing this one simple thing to help avoid fatal mistakes.

azcomp technologies sells medisoft and lytec practice management and EHR software

You’ve probably heard our purpose here at AZCOMP- “Empowering Small Practices to Deliver the Best Care”.  Some may think those are just words, or a catchy slogan that we came up with- but those words have deep meaning for us here at AZCOMP.

Obviously, we don’t work directly with your patients- and we aren’t so arrogant to think that we can help out with delivering health care.  This is what we are doing here though- playing for the patients. Every patient is someone’s mom, grandpa, neice, brother, daughter, or best friend and we think that every patient deserves the best care possible.  

Even though we aren’t doctors or nurses, we firmly believe that what we do here helps give small and independent practices the tools they need to make their practice run smoothly, thus enabling or empowering these practices to focus on delivering the best patient care that they are capable of.

Sometimes we hear stories that light this fire in us and make us more passionate about what we do- and sometimes we live those stories ourselves. And today we wanted to share the story of one of our own employees.

A Sad Story

About a year ago, one of our employee’s didn’t come into work because her mother had suddenly slipped into a coma. After a very scary and heart-wrenching time in the ICU they finally figured out the problem and were able to save her life. The Problem: Her doctor was not checking for drug interactions and had her on a combo of meds that were shutting her kidneys down and started a cascade of problems that affected her heart and brain. She almost lost her mother over a simple mistake.

Mistakes happen- But, this mistake could have and should have been avoided.

The doctor who wrote the prescription at one point had an EMR demo and quote from us and decided for whatever reason not to make the switch to EMR. If the doctor had been using our EMR and electronically prescribing, the software would have immediately caught the mistake and flagged the doctor who was writing the prescription. This life threatening mistake never would have happened.

Fortunately this mistake was corrected and her mother is still with us. But unfortunately thousands suffer or die each day in the United States from prescription errors. Can you imagine how many lives would be saved if every doctor were checking their prescriptions for drug interactions? It is for reasons like this that we are so passionate about what we do at AZCOMP.  We aren’t just selling software, we are making a difference.

Every provider needs to electronically prescribe and check for drug interactions- period.

If you truly want to give your patients the best care and avoid life threatening mistakes then call us today- we can help!

Your Turn To Share

Do you have a story about how the tools you use help your practice to deliver better health care than you could have without it?  We’d love to hear about it.  Please share your inspirational story in the comments below.

Update: FINAL Surescripts Compliance Deadline

Important News Regarding the Surescripts 10.6 Compliance Deadline

Mid-morning on Friday, October 3, 2014 we received information from McKesson with an update regarding the Surescripts 10.6 Compliance Deadline.  We want to make sure that our customers have the most up to date information so we are passing this information along.

This is the information that we received from McKesson:

FINAL Surescripts 10.6 Compliance Deadline

“Dear Value Added Resellers:

“We have now received a formal message from Surescripts regarding the deadline for compliance with their 10.6 Sunset Policy for Routing and Medication History.  In summary, Surescripts is giving vendors until December 31, 2014, to become compliant with their 10.6 protocol.  [McKesson is] already compliant and has been since early this year.  Our compliant versions are Practice Partner v11.0, Medisoft Clinical v19 SP1, and Lytec MD 2014 SP1.  No other versions of Practice Partner, Medisoft Clinical, or Lytec MD are/will be compliant with this requirement.  Customers have until June 30, 2015 to upgrade to an EMR that is compliant with the 10.6 protocol.  Beginning on July 1, 2015, Surescripts will reject all pre-10.6 or 4010 transactions and only users transacting on 10.6 and 5010A1 will be able to send Routing, Medication History or Eligibility transactions.

“We strongly encourage all customers to upgrade to Practice Partner v11.0, Medisoft Clinical v19 SP1, or Lytec MD 2014 SP1 before the end of the year, and not wait until the deadline.  This not only ensures that they are compliant with Surescripts, but that they are also well positioned.”

McKesson also provided us with this information that is directly from Surescripts:

“Surescripts has worked with many of our customers to ensure compliance with our 10.6 Sunset Policy for Routing and Medication History, as well as Eligibility 5010A1, in support of CMS requirements.  If you are already in compliance, we appreciate your timely attention to this matter, and we recognize that this required a significant amount of work to be in compliance.

“If you are not yet in compliance, please consider this our final notification regarding upcoming deadlines.  In order to support your efforts to finalize your 10.6 deployment, we are granting a final deadline extension through December 31, 2014.  If you are not certified and fully deployed with 10.6 and/or 5010A1 requirements by January 1, 2015, you will be considered “out of compliance”.

“Beginning on July 1, 2015, Surescripts will reject all pre-10.6 or 4010 transactions and only users transacting on 10.6 and 5010A1 will be able to send routing, Medication History or Eligibility transactions.”

Being Prepared For The Future

Again, we want our customers to have the most up to date information and that is why we are posting about this.  If you have not upgraded to the latest version of Medisoft Clinical, Lytec MD or Practice Partner (v11),  you should not delay.  We highly recommend that you prioritize upgrading in the near future to make sure that you are in compliance with Surescripts and in a good position having the latest version of the software.  The only way to ensure that you are compliant with any regulatory changes such as this is to be on the latest version of your EHR software.

A note about Meaningful Use

Lastly, if you plan to meet meaningful use in 2015, that is another reason that you will need to upgrade to the latest EMR version.  Meaningful Use and Surescripts requirements are independent of each other.  You will need to be upgraded prior to January 1, 2015 if you plan to meet meaningful use.

If you need to schedule your version 11 upgrade, or if you have any questions about any of this information, please contact our office at (480) 730-3055.  Another option is that you can leave a comment or a question in the comments section below.  We’ll be sure to answer any questions that you submit.

Disclaimer: AZCOMP Technologies, Inc, (AZCOMP) is providing this material as an informational reference for healthcare providers. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of posting, the Medicare/Medicaid programs are constantly changing, and it is the sole responsibility of each provider to remain abreast of  program requirements by consulting the authorities and directly from their the source at

How To Restart A Prescription When It Is Stuck At the SureScripts Server In Medisoft Clinical or Lytec MD

AZCOMP Support Video: What to do when a prescription is stuck in the SureScripts server of your EMR.

This is an error that occurs when you’ve sent a prescription to the pharmacy but yet in your system it still says “transmitted”.  When that occurs there is usually some sort of miss-communication with the server at SureScripts, which is where all of the prescriptions go through when they are getting transmitted.  It is pretty easy to re-set this and fix the problem.  Watch this short video to see how you can fix the problem.  This video is shown in Medisoft Clinical but is also the same in Lytec MD EHR systems.

If you like this video or if you thought it was helpful, be sure to click the “like” or “thumbs up” button in YouTube.  If you want to see more videos like this you can subscribe to our channel to get the new videos when they come out.  Leave us a comment or ask us a question below in the comments section if you need help with anything else.

Here is the video…(don’t forget you can increase the size of the video to ‘full screen’ by clicking the icon in the bottom right hand corner of the screen)

Rx Fill History & Recording Patient Consent

Use The Rx Fill History with e-Prescribing in Medisoft Clinical or Lytec MD

The Rx Fill History tab under the Rx/Medications section of the patient’s chart is a valuable tool that is designed to help physicians reconcile medication in order to prevent adverse drug interactions or overdose.

Note: The Rx Fill History tab is only available to providers enrolled in ePrescribing.

The Rx Fill History tab displays pharmacy fill events downloaded to your system from the patient’s Pharmacy Benefits Manager. This feature allows you to see details of what medications your patient is actually obtaining from pharmacies, whether they were prescribed by you or another physician.

You can obtain or refresh the fill history by clicking the Update Fill Hx button, which will initiate a live download of data from the patient’s Pharmacy Benefits Manager. (This feature is limited to what the Pharmacy Benefits Manager provides. It may not contain a complete list of all medications for any particular patient, and it may not be available for all patients.)

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Once data has been downloaded you can view detailed information about a prescription by selecting the prescription from the list and clicking the Show Detail button. The Medication Fill History Detail screen will appear with detailed information about the prescription.

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You can use the Fill History to update the Current Medications list by clicking the Add to Current Meds button.

Considerations Regarding Patient Privacy& Practice Liability:

It is up to the practice to make sure they are gaining patient consent before accessing a patient’s medication history through their e-prescribing/EMR software system. Surescripts does not provide any sort of form/template for gaining patient consent. As a network, Surescripts does not mandate how a prescriber obtains consent-whether this is done orally or in writing (although the prescriber must act in accordance with the applicable law where they are practicing).

Sample wording for a signed consent:

“I understand that performing a medication reconciliation in order to prevent adverse drug interactions and overdose is a critical component to my care. By signing this form I authorize my provider to query and review my medication fill history including drug, dose, form, strength, prescribing provider, and pharmacy.”

Optional Security Settings:

Access Levels can be used to limit access to the Rx Fill History features to only those users that should have access. Your system administrator grants or denies access to these features by going to Maintenance/Setup/Access Levels, selecting the access level and hitting the Edit button.

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On the Records tab the “Rx Fill History Request” should only be checked for users that should have the ability to request the fill history information. And “Rx Fill History” should be checked for users that should have access to view the Rx Fill History tab of the Medications Screen.

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By default the system is setup with the assumption that either a written or oral consent has been obtained, however there is a feature that can be enabled to require users to record in the patient record that consent has been obtained. This would prevent the download of fill history data for any patients that had no indication that consent had been obtained.

To set this feature up the Administrator must edit the ppart.ini file (Found in the ppart directory on the server), changing the current setting of “RxFillHxCheckConsent=OFF” to “RxFillHxCheckConsent=ON

The next step is to create a new question under the patient demographics screen. The “Other Data” tab in the patient’s chart is a place where you can create custom fields to record information on a patient that is not otherwise tracked in the chart. We will setup a question on this tab to indicate whether or not the patient has given consent to obtain Rx Fill History.

Select Maintenance/Configuration/Define Other Data/Patient

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When the Patient Define Other Data Select screen appears, click on the New button.

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Enter Rx Fill Hx OK? in the Label field, select Text from the Type drop-down list, and select 1 Character from the Length drop-down list. Enter a Description and hit OK.

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The Rx Fill Hx OK? field will now appear on the Other Data tab of the Patient screen.

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You will need to establish a workflow where patients (or, for minor patients, their guardian) are informed that their pharmacy benefits provider provides information about the medications they have had filled at retail and mail-order pharmacies, and asked for their consent to request that data for medications prescribed by all providers, providers at your site, or not at all. You can enter the following values in the Rx Fill Hx OK? field based on the patient’s response:

– Enter “Y” if the patient gives consent for all providers.

– Enter “P” if the patient gives consent for providers at your site.

– Enter “N” if the patient does not give consent.

Note: The response must be entered in as a single character and must be in uppercase for the feature to work.

Closing Screen Clinical