PerformRxSM Investigational Audits Are on the Rise
PAAS National® has recently seen a new trend with investigational audits completed by PerformRxSM. These audits are a combination of an invoice, desk, and a compliance audit.
Entries by Dana Westberg, CPhT
Prepare Yourselves! Onsite Audits Are Coming in Strong
Health and Human Services (HHS) is planning for the public health emergency (PHE) to expire on May 11, 2023 and PBM auditors are in full swing of resuming their onsite visits. Onsite audits have always been the most aggressive and highest risk to community pharmacies.
LTC Is Different … Do Auditors Agree?
PAAS National® analysts frequently assist pharmacies that service LTC facilities. Three audit flags PAAS analysts frequently see for LTC pharmacies
Update to PAAS’ Onsite Credentialing Guidelines
PAAS National® has created an Onsite Credentialing Guidelines, an extensive checklist to assist PAAS members with scheduled and/or unexpected visits from PBM auditors. Unannounced visits can catch pharmacy staff off guard when the Pharmacist-in-Charge (PIC) is not present.
Start of New Year = Opioid Plan Rejects
PAAS National® analysts receive numerous calls at the start of the new year looking for guidance on opioid plan rejects.
Prescriber Statement Requirements Needed for Prescription Discrepancies
Appealing audit discrepancies can be confusing and time consuming. PAAS National® analysts have over 50 years of dedicated audit assistance experience, and review nearly 10,000 audits a year.
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.
“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?
