Entries by Sara Hathaway, PharmD

Avoid This Billing Pitfall with Your Medicare Part B Nebulizer Solution Claims

Correctly billing Medicare Part B can be tough. The Local Coverage Determinations and associated Policy Articles for each DMEPOS category, along with the Standard Documentation Requirements for All Claims Submitted to DME MACs, are filled with billing and documentation guidelines which suppliers must fully comprehend and follow to avoid claim chargeback.

Do The Math and Avoid the Recoupment

Proper mathematical calculations are critical to billing prescriptions correctly. The action of translating directions on the prescription into a mathematical equation seems simple, but PAAS National® analysts see claims billed with incorrect days’ supply every day!

NEW Dispense as Written (DAW) Code Revealed

Chances are you have come across a claim or two (or several thousand!) with a DAW code of 1, 2, or 9. Pharmacy staff are usually knowledgeable about when to use these DAW codes – that a DAW 1 may be appropriate to use when the prescriber does not authorize generic substitution on a multi-source brand, a DAW 2 when the patient requested the brand name, and a DAW 9 when the plan explicitly indicates the brand name product is preferred.

Auditors Are Drawn to Santyl® Like Moths to a Flame

Summer is here and so are the bugs! While mosquitos, gnats, moths and the like have next to nothing to do with Santyl® ointment for debriding chronic dermal ulcers and severely burned areas, the visualization of auditors being drawn to claims for Santyl® ointment being akin to moths (or other bugs) being drawn to a flame is a parallel not to be ignored.