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®.
I grew up in a family of nurses and other medical professionals but was never interested in the clinic setting. I was drawn to pharmacy because I like to help people and could easily use the knowledge I grew up with to do so. It was a great fit.
I have a Bachelor of Arts in Communications from the University of Wisconsin – Madison. Prior to joining PAAS in 2017, I worked for Walgreens for 19 years.
As an Analyst at PAAS, I really enjoy being able to help independent pharmacies succeed. I have always been a fan of the underdog and am excited to be able to give you the tools you need to take on the giants of the PBM industry.
Unfortunately, the cost difference can be significant, leading to an increased risk for audit – especially when a patient is taking Glumetza® or Fortamet®.
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.
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…
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:
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.
All PBM agreements contain language requiring pharmacies to collect copays and be able to prove those copays were collected if audited.
Many pharmacies struggle with DMEPOS audits due to the complexity in medical billing and the onerous documentation requirements.
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.
Many pharmacies struggle with DMEPOS audits due to the complexity in medical billing and the onerous documentation requirements.
e know that days’ supply should be billed based on the mathematically calculable directions, but what happens when the days’ supply does not fall in the easily calculable 30- or 90-day spectrum? What if it is “weird?”
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