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.
Entries by Jenevra Azzopardi, CPhT
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:
Distribution Required: Medicare Prescription Drug Coverage and Your Rights (CMS-10147)
When a pharmacy receives a rejection for a claim not being covered by Medicare Part D, the pharmacy must provide the patient with the CMS-10147 form, also known as the Medicare Prescription Drug Coverage and Your Rights.
Required: Proof of Patient Copay Collection
All PBM agreements contain language requiring pharmacies to collect copays and be able to prove those copays were collected if audited.
2024 DMEPOS Series #2: Nebulizer Solutions
Many pharmacies struggle with DMEPOS audits due to the complexity in medical billing and the onerous documentation requirements.
Early Refills of Titrated Medications Lead to Recoupments
Titration is a common practice for certain medications where prescribers start a patient on a low dose and gradually increase the amount over time to find what’s most effective.
