The $40 Incentive Fee You Might Be Missing!
Since 2021, a program created by CMS has allowed eligible pharmacies to receive additional reimbursement for administering the COVID-19 vaccine to certain Medicare homebound patients.
Entries by Heaven Bennett, CPhT
Final Audit Results…Or Are They?
Receiving audit results that have discrepancies with financial recoupment is never something a pharmacy wants to endure, but PAAS National®® is here to help! It is important to know that audit results may not provide all potential avenues for appeal. Even if your initial appeal is denied, there may still be an opportunity to overturn […]
Do You Have Adequate Proof of Patient Copay Collection?
PBMs require pharmacies to not only collect patient copays, but also have documentation to prove it. It is common for PBMs to request proof of copay collection when performing audits. Copays are used by the insurers to help patients understand medication costs and to encourage less costly alternatives. Pharmacies that alter or waive copays set […]
Are You Billing Divigel® Correctly?
Billing packaged products according to their proper size and unit of measure is crucial for pharmacies, as this common pitfall could result in hefty recoupments from PBMs. When it comes to billing insurance, a medication like Divigel® (estradiol) transdermal gel packets can be confusing for pharmacies, as different strengths use different billing units. Some are […]
When Medicaid is the Secondary Payor
Billing insurance isn’t always simple, whether it’s formulary issues, step therapy or plan limitations, it’s common for a pharmacy to receive a rejection when trying to bill a patient’s insurance. For patients with Medicaid as secondary coverage, can you simply send the rejected claim to Medicaid? Caution should be exercised.
DEA Alert: Electronic Prescription Fraud on the Rise
As technology continues to reshape modern medicine, medical providers have embraced electronic prescribing to improve patient care. Unfortunately, as the healthcare landscape evolves, so do the tactics of bad actors seeking to exploit it. Bad actors can use stolen login credentials from prescribers to gain access to electronic health record systems and initiate thousands of […]
Billing and Filling: Glucagon Emergency Products
Glucagon emergency products are typically low audit risk – when billed correctly. Billing the wrong unit of measure, like “EA” instead of “mL”, is an easy target for auditors to flag. Below is a table to aid in billing the correct unit of measure.
Changing Pharmacy Management Software? Don’t Neglect Record Retention!
When updating or changing pharmacy management software systems, pharmacies may be presented with different options to archive the files from the software they will no longer be using. While it may not seem worth the extra cost now, ensuring that you are able to retrieve appropriate data for old claims is crucial to avoiding costly […]
Can Claims Under Audit Be Reversed?
You’re preparing for an upcoming desk audit, and while pulling the hard copies for a PAAS National®® analyst to review, you notice a billing error. It’s a simple fix, like an incorrect days’ supply, so you try to reprocess the claim. However, now you’re hit with an unexpected rejection …
Tennessee Pharmacist Conducts Multi-Million Dollar Health Care Fraud Scheme
In December 2024, a Tennessee pharmacist was arrested and charged with nine counts of Health Care Fraud and six counts of Aggravated Identity Theft for operating a health care fraud scheme that resulted in over $6 million worth of false claims being submitted to several insurers. A federal indictment returned in late December revealed that […]
