Audit Target – Pre-Filled Injectable Pens and Syringes
Audit Target – Pre-Filled Injectable Pens and Syringes
Pre-filled injectable medication such as insulin, Invega®, Humira®, Enbrel® and Ozempic® remain a big target for audit risk due to their high cost and potential billing pitfalls. One claim error can cost you thousands of dollars. PAAS National® often sees prescriptions for pre-filled injectable medications flagged for recoupment due to one or more of the following reasons:
- Missing a unit of measure (UOM) or written for a UOM that does not make sense
- Missing dosage or quantity to inject
- Missing the route of administration (ROA)
- Missing calculable instructions/frequency
PAAS Tips:
- Here is a Humira prescription example:
- The quantity of #1 could be interpreted as 1 pen when the box comes as a kit and contains 2 pens
- There is no UOM, so does the prescriber want 1 box, 1 mL, 1 pen, 1 kit?
- The SIG does not contain calculable instructions = how much to inject, where to inject (ROA) or how often to inject
- If the pharmacy received this prescription and did not clarify any elements, it would be marked discrepant upon audit.
- Upon receiving this prescription, ideally, the pharmacy would clarify the following elements with the prescriber’s office and make a clinical notation
- Quantity of 1 = 1 kit or 2 pens
- SIG – Inject 40 mg subcutaneously once a week – this clarifies how much to inject, the ROA and how often to inject
- Utilize the PAAS National® Self-Audit Mindset tool when reviewing prescription
- Pay special attention to pre-filled injectable pens and syringes to avoid thousands of dollars of chargebacks upon an audit
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