In 2019, the FDA required new labeling for insulin pen packages that states, “Dispense in this sealed carton”. The rationale was pursuant to a Tracked Safety Issue which cited concerns for dispensing errors, counterfeit product and failure to include the patient instructions for use with each dispensing. Since that time, PAAS National®® has recommended …
While PAAS National®® may be known for our best-in-class, hands-on audit assistance, we also offer insightful and educational information and resources that you may be missing out on! Below is a list of resources found in the Audit Assistance section of the Member Portal that could help ensure you and your pharmacy staff stay educated […]
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.
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 […]
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 […]
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 […]
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.
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 […]
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.
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 […]
