SIRCDIS007
Administer dispensary computer systems and claims


Application

This unit describes the performance outcomes, skills and knowledge required to assist pharmacists with a range of administrative requirements. It requires the ability to maintain the dispensary computer system and to prepare and reconcile Pharmaceutical Benefits Scheme (PBS) claims.

This unit applies to senior dispensary assistants working in community pharmacies. When administering customer records and pharmacy claims they work under the direct supervision of a pharmacist and their role is limited to those functions that do not require them to exercise professional pharmaceutical judgement or discretion.

No occupational licensing, certification or specific legislative requirements apply to this unit at the time of publication.


Elements and Performance Criteria

ELEMENTS

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Maintain dispensary computer system.

1.1.Follow organisational procedures for maintaining computer systems, data and privacy of customer information.

1.2.Interpret and follow technical instructions for computer system maintenance.

1.3.Back up computer data regularly and ensure currency of dispensary and virus protection software.

2. Monitor and use system information.

2.1.Update dispensary system data regularly to ensure accuracy and currency.

2.2.Provide clear information to pharmacist about changes to dispensary system data and seek guidance on issues requiring pharmacist instruction.

2.3.Generate, review and distribute regular dispensary reports.

2.4.Identify customer information for follow up in relation to additional services or programs and advise pharmacist.

2.5.Generate documentation that supports pharmacist interactions with customers about services and programs.

2.6.Protect customer privacy and ensure confidentiality of stored information.

2.7.Minimise use of printed materials and maximise electronic transmission and record keeping to reduce waste.

3. Prepare PBS claims.

3.1.Follow organisational procedures for administering and reconciling claims.

3.2.Interpret and adapt to changing requirements for claims lodgement.

3.3.Close off prescription claim period, as directed by pharmacist, to meet Medicare Australia and PBS claim deadlines.

3.4.Check prescription forms for patient or agent signature and date.

3.5.Prepare accurate and complete claims.

3.6.Collate prescriptions into patient groups.

3.7.Check serial numbers, identify and refer missing serial numbers to pharmacist.

3.8.Refer completed hard and soft copy claims data to pharmacist for sign-off, and lodge with Medicare Australia.

4. Reconcile Medicare Australia payments.

4.1.Analyse and reconcile Medicare Australia payments against data lodged by pharmacy for the claim period.

4.2.Identify and resolve reconciliation discrepancies within scope of own role.

4.3.Identify outstanding payments and refer to pharmacist.

4.4.Identify out-of-period adjustments from prior claims and refer to pharmacist.

Evidence of Performance

Evidence of the ability to complete tasks outlined in elements and performance criteria of this unit in the context of the job role, and:

complete each of these types of computer maintenance activities:

data back-up

virus software updates

dispensary software updates

dispensary system data updates

generate each of these types of reports:

clinical reports

financial reports

online claims reports

administer and reconcile Pharmaceutical Benefits Scheme (PBS) claims:

prepare and lodge claims for two reporting periods

reconcile payments against claims for two reporting periods

identify outstanding payments and refer to pharmacist across two reporting periods

identify out-of-period adjustments from prior claims and refer to pharmacist across two reporting periods.


Evidence of Knowledge

Demonstrated knowledge required to complete the tasks outlined in elements and performance criteria of this unit:

role boundaries and responsibilities of dispensary assistants and pharmacists in maintaining dispensary system data and administering and reconciling PBS claims

organisational procedures for:

maintaining computer systems and data

maintaining privacy and confidentiality of customer information

preparing, submitting and reconciling PBS claims

features and functions of dispensary software specifically for:

data maintenance

generating and distributing reports

preparing, submitting and reconciling PBS claims

formats, content and use of dispensary reports, including terminology:

clinical reports

financial reports

online claims reports

types of information generated by dispensary systems to alert pharmacist of customer need or eligibility for additional services or programs, including those related to compliance, and their documentation requirements:

Home Medicine Review

MedsCheck

key features of PBS payment entitlements for different types of customers:

payments for general customers without concessional cards

payments for concessional customers

sources of information and instructions for preparing PBS claims, including those related to:

PBS online

error/rejection messages and how to action

paper-based claims

submission methods

Medicare Australia claims procedures for preparing and submitting online and paper based claim forms

required claim information:

prescription endorsement and identification

serial numbers

price claimed for:

elected PBS prescriptions

exceptional PBS prescriptions

Repatriation Pharmaceutical Benefits Scheme (RPBS) prescriptions for items not included in the PBS or RPBS Schedule.


Assessment Conditions

Skills must be demonstrated in a pharmacy with a designated operational dispensary and administration area. This must be in an industry workplace, which meets Pharmacy Board of Australia and relevant industry standards for dispensary operations.

Assessment must ensure use of:

information technology hardware and software

dispensary software currently used by the community pharmacy industry

online PBS claims systems

template dispensary reports:

clinical reports

financial reports

online claims reports

PBS claims documentation

endorsed prescriptions with stickers or stamps, ready for claiming

organisational procedures for:

maintaining computer systems and data

maintaining privacy and confidentiality of customer information

preparing, submitting and reconciling PBS claims

pharmacists with whom the individual can interact

assessment activities that allow the individual to work with commercial speed, timing and productivity to complete PBS claims within nominated deadlines.

Assessors must satisfy the Standards for Registered Training Organisation’s requirements for assessors, and:

have worked in the pharmacy sector for at least two years.


Foundation Skills

Foundation skills essential to performance are explicit in the performance criteria of this unit of competency.


Sectors

Community Pharmacy


Competency Field

Dispensary