Missing DUR and SCC Documentation Can Lead to Recoupment!
Many pharmacy teams are overwhelmed with the increasing daily workload. This can result in data entry staff creating shortcuts, like entering override codes to get claims processed.
Entries by Dana Westberg, CPhT
“Unauthorized Refills” Audit Discrepancies; How Does This Happen?
Audit results flagging “unauthorized refills” or “overbilled quantity,” can lead to big recoupments.
Flu Shot Season Is Here – What Is Needed for Audit?
COVID-19 has forced a significant increase in the number of vaccinations pharmacies do daily. With this increase also comes additional audits.
Could You Be Giving Vaginal Creams Away for Free?
PAAS National® analysts continue to see claims for Premarin® and Estrace® creams being audited and recouped. Are you in jeopardy?
Is Your Pharmacy Ready for an Unannounced Audit?
Pharmacies are often startled with the limited amount of time a PBM offers prior to an onsite audit. However, PBM auditors, DEA agents, FDA inspectors and state Board of Pharmacy inspectors can also make unannounced visits.
New Dispensing Platform? Be Ready in Case of an Audit!
Pharmacies updating or changing their dispensing platform may face unique audit issues.
Yes, OTC COVID-19 Tests Can Be Audited!
Dispensing OTC COVID-19 tests is widespread through community pharmacies. Pharmacies must be aware that submitting claims to PBMs for these tests opens the window for auditing. Ensuring you have procedures in place to accurately purchase, bill and dispense these home tests is imperative. While the dollar amount of these claims does not seem audit worthy, PBMs will be checking for Fraud, Waste and Abuse and contract violations.
Insulin for a Pump – Medicare B or Medicare D?
Be sure you know how to correctly bill your patients’ insulin.
Beware and Be Ready! In-Person Onsite Audits Are Resuming
OptumRx and Express Scripts recently sent notices to pharmacies informing them in-person onsite audits will be starting back up in April.
Caremark® Turns Up the Heat on Proof of Copay Collection Requests
PAAS National® is seeing a rising number of Caremark® audits requesting proof of copay collection. This requested information may be included in a desk, virtual onsite, or invoice audit. The number of claims requested can range from just a few claims to all dates of fill for several prescriptions.
