Insulin Pens: Understanding Dosing Increments and Audit Risks
PAAS National® continues to see auditors flag insulin pen prescriptions for containing a dosage that does not align with the product.
Entries by Jenevra Azzopardi, CPhT
What to Do (and Not Do) When Your Days’ Supply is Rejected
Insurance companies require pharmacies to bill an accurate days’ supply based on mathematical calculations from the directions.
2024 DMEPOS Series #7: Therapeutic Shoes for Diabetics
Many pharmacies struggle with DMEPOS audits due to the complexity in medical billing and the onerous documentation requirements.
Back to School: How to Ace EpiPen® Billing and Avoid an Audit
PAAS National® has seen an increase in prescription validation requests and audits for EpiPen® and, with back-to-school in full swing, we want all pharmacy employees to be aware of potential billing issues for this life-saving medication.
2024 DMEPOS Series #6: Immunosuppressive Drugs for Transplant
Many pharmacies struggle with DMEPOS audits due to the complexity in medical billing and the onerous documentation requirements.
DAW 8: Documentation When the Generic is Not Available
DAW code billing on multi-source brand medications is a frequent audit target for PBMs due to their potential higher cost, change in pharmacy reimbursement, and impact on patient copays. PAAS National® recommends …
Metformin HCl ER – Audit Considerations
Unfortunately, the cost difference can be significant, leading to an increased risk for audit – especially when a patient is taking Glumetza® or Fortamet®.
Diagnosis Restricted? Documentation Required!
PAAS National® is starting to see more audit recoupments on claims where a diagnosis code was required at adjudication but there was no documentation on the hardcopy to support the diagnosis code billed.
2024 DMEPOS Series #4: Surgical Dressings
This DMEPOS series is intended to help you understand these complexities and gather the needed documents. In particular, you should be able to show the following if audited on surgical dressings…
2024 DMEPOS Series #3: Ostomy Supplies
This DMEPOS series is intended to help you understand these complexities and gather the needed documents. In particular, you should be able to show the following if audited on ostomy supplies:
