Illegible Signature? Auditors Are Taking Note!
A recent audit trend shows that some major PBMs are challenging the perceived legitimacy of patient signatures. In particular…
Entries by Jenevra Azzopardi, CPhT
From Problem to Progress: Best Practices for Corrective Action Plans (CAP)
A Corrective Action Plan (CAP) is a document your pharmacy may develop in response to issues that arise (e.g., negative audit findings), helping to identify root causes, and how your pharmacy will prevent the same discrepancies from happening in the future. You may choose to develop your own informal CAP to help train or retrain […]
Days’ Supply Mistakes: A Fast Track to Recoupment
Calculating the days’ supply on a claim is something every pharmacy does throughout the workday. With a multitude of claims, clerical errors are bound to happen. What are the audit consequences when a days’ supply is billed incorrectly?
Unannounced CMS Site Visits
PAAS National®® has recently seen an uptick in the number of unannounced CMS site visits related to Medicare enrollment or revalidation. These visits are currently being conducted by Novitas Solutions, the contracted National Provider Enrollment East (NPEast) contractor and Palmetto GBA® for the NPWest. Site visits are performed to verify the business location and ensure […]
LTC Essentials: A Guide to Residence Codes, Pharmacy Service Types, and Submission Clarification Codes
With more pharmacies exploring the world of long-term care and LTC Pharmacy at Home dispensing increasing daily, PAAS National®® has also been seeing audits on these claims. One area PBMs have been targeting surrounds…
Update: Isentress® and Dificid® Added to Dispense in Original Container Chart
OptumRx continues to focus audits on prescriptions that must be dispensed in their original container per the manufacturer’s [FDA approved] labeling and package insert.
Oral Inhalers – What You Need to Know About Institutional Pack Sizes
Oral inhaler prescriptions are frequently targeted for audit by PBMs because of their cost, frequent billing errors (e.g., incorrect days’ supply), or prescribing errors (e.g., non-mathematically calculable directions or incorrect written quantity). Vague written quantities can cause recoupments when multiple package sizes exist, including institutional package sizes.
Mailing Prescriptions? How to Ensure Audit Success
While some pharmacies make mailing prescriptions a regular practice, others may only do so on a case-by-case basis. PBMs require signature logs to prove that a patient received their medication in a timely manner, but how is proof obtained when the patient is not standing in front of you at the pharmacy counter?
Forteo® Package Size Update – Compendia Adjustment Expected April 1, 2025
As previously reported by PAAS National®® in our December 2024 Newsline article, the FDA revised the product labeling for Forteo® (teriparatide injection) and its generics to accurately reflect the amount of drug delivered to the patient and not the overfill existing in the pen injector delivery device (from a 600 mcg/2.4 mL pen to a 560 mcg/2.24 mL […]
Unique Eyedrop Calculation Challenges
Pharmacy social media platforms host passionate discussions on the correct way to bill days’ supply for eyedrops almost every week. Do you use 15 drops/mL, 20 drops/mL, or something else? As it turns out, the “right answer” depends on the PBM you are billing and if the eyedrop is a solution or a suspension. Sound […]
