Billing the accurate days’ supply for eye drops can be challenging. Despite what is drilled into pharmacists during schooling, there is no industry standard for drops/mL, and PBMs often use their own specific conversion factors.
Compound prescriptions may not be a frequent occurrence for some pharmacies; however, those that do bill compounds must be aware of the audit risks.
Pharmacies need to be aware of the risks of billing claims [to Medicare B/D] for patients under a Medicare Part A stay.
PAAS National® analysts continue to see audit results flagging “unauthorized refills” or “excessive quantity billed”.
In recent years, there has been a notable increase in the number of medications prescribed for migraine prevention and treatment. This increase leads to additional audit risks.
Pharmacy staff frequently receive prescriptions from prescribers that lack (or are missing) complete quantities or instructions for use. Clarifying these details before dispensing can help prevent audit discrepancies.
PAAS National® analysts continue to see pharmacies face recoupment on audits due to return to stock violations.
One of the most common questions PAAS National® receives from our members is: what are the requirements for audits when signature logs are requested.
Topical medications are easy audit targets, especially with the rising costs of some of these medications.
Making sure your transferred prescriptions are complete can be one of the easiest audit recoupments to prevent.
