Avoiding Recoupments: Why Accurate 11-Digit NDC Billing Matters
Matching all 11-digits of the NDC billed to the NDC dispensed is one critical step in ensuring the pharmacy has adequate records to support the appropriateness of every claim billed.
Entries by Sara Hathaway, PharmD
Verify Day’s Supply on CeQur Simplicity Meal-Time Insulin Patch
CeQur SimplicityTM is a meal-time insulin patch approved for use in adult patients (over the age of 21) with Type 2 Diabetes and can replace up to 12 meal-time insulin doses. The patch delivers rapid-acting insulin in 2-unit doses through a flexible cannula by depressing two buttons, one on each side of the patch. This […]
When the Margins Are Thin, Self-Audit for the Win
It is no secret that margins on prescription medications have declined dramatically over the last few decades. Independent pharmacy owners are well aware of their less-than-favorable Pharmacy Benefit Manager (PBM) contracts, and their propensity to routinely audit. After working day in and day out to take care of the patients in your communities, auditors swoop […]
The Next Big Wave: Anticipating a Surge in HIPAA Compliance Audits
Desk audits, onsite audits, invoice audits…and HIPAA compliance audits?! Unfortunately every community pharmacy has some familiarity with third party payor audits, and PAAS National®® audit analysts bring their expertise to guide members through the entire audit process, ensuring everything goes as smoothly as possible. But what about HIPAA compliance audits? With a potential surge in these […]
The NEW Inventory Transfer Log and Why it Could Save You Big!
PAAS National®® analysts have walked many pharmacies through the ins and outs of invoice audits. During our consultations with members who have their results back, the question of “Why would my invoice not be accepted?” comes up regularly. The answer to this question is multifaceted and can take some investigative work to identify the root cause. […]
The HIPAA Hot Seat: What You Need to Know About the “2024 Privacy Rule” and Reproductive Health Care
The 2022 Dobbs v. Jackson Women’s Health Organization ruling, which overturned Roe V. Wade, prompted modifications to the Privacy Rule (45 CFR Parts 160 and 164). The Biden-Harris administration, partially through President Biden’s Executive Order (EO) 14076, aimed to better protect information related to reproductive health care, to bolster patient-provider confidentiality, and promote trust between […]
2025 PAAS Fraud, Waste & Abuse and HIPAA Compliance Program Updates
PAAS National®®® continuously monitors legislative and regulatory changes that may impact your Fraud, Waste & Abuse and HIPAA Compliance Program. We keep a close eye on enforcement from the Department of Justice, Office of Inspector General, State Attorney Generals, and Office for Civil Rights to help ensure the program meets interpretative standards. Furthermore, PAAS works […]
CMS Updates HIV PrEP Supply Fee Code, Effective 01/01/2025
In December 2024, PAAS National®® brought you the Medicare Part B Coverage of HIV PrEP Newsline article which provided an in-depth look into appropriately billing HIV PrEP medications to Medicare Part B. The original shift from billing these medications from Medicare Part D to Part B was effective just a few months ago (September 30, […]
Medicare Part B Coverage of HIV PrEP
As of September 30th, 2024 there was an industry shift from billing HIV Pre-Exposure Prophylaxis therapy (PrEP) from Medicare Part D to Medicare Part B. This shift to Part B coverage falls under section 1861(ddd)(1) of the Social Security Act using the “additional preventative services” benefit. Due to the high cost of HIV PrEP medications, […]
Hundreds of Patient Information Requests for Medicare: What This Means for Your Pharmacy
Pharmacy personnel are all tasked with keeping patient protected health information (PHI) secure.
