2024 Self-Audit Series #4: Transferred Prescriptions

Making sure your transferred prescriptions are complete can be one of the easiest audit recoupments to prevent.

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Each state’s Board of Pharmacy outlines in their laws what is required to be included on a transferred prescription, and auditors love to identify missing information and marking the claim discrepant. Pharmacies should educate themselves on the individual requirements to avoid big recoupments during audit.

Transferred prescriptions can easily be targeted for audit based on the origin code billed on the claim. High dollar claims with an Origin Code of 5 have an increased likelihood for audit. Consider utilizing this information to self-audit your transferred prescriptions on a regular basis.

PAAS Tips:

  • Do not assume faxes you receive from other pharmacies are complete, missing requirements only affect your claims during an audit
  • Refresh your staff’s knowledge with your state’s current prescription transfer laws
  • Consider creating or utilizing transfer prescription blanks that include all required elements for your state
  • When using software transfer fields, consult with your PMS vendor to ensure all information is included and be sure to include this “screen shot” during audit
  • Run internal reports on a regular basis to review your transferred prescriptions
  • Be sure written dates are entered correctly to avoid filling past expiration
  • Always double check that quantities and refills are entered accurately to avoid billing over what is remaining on the prescription.
  • Origin code “5” should be billed for all transferred prescriptions.
  • Contact PAAS National®® analysts with questions or concerns on your transferred prescription, info@paasnational.com or (608) 873-1342.

Dana Westberg, CPhT