Automatic Prescription Refill Concerns
Many pharmacies use an automatic refill process to streamline the labor needed to fill prescriptions.
Entries by Jenevra Azzopardi, CPhT
Are You Ready for Flu Shot Season? Auditors Are!
It is that time of year again; flu shot season is upon us. As busy as this season can be, we know you do not want to worry if you have all the documentation you need in case of an audit.
Electronic Clinical Notes: Are They Required?
There has been some discussion in pharmacy circles about clinical notes and whether PBMs are requiring them to be electronically annotated (or if hand-written clinical notes will continue to suffice).
Billing Test Claims? It Can Cost You!
We have all been there – a prescriber calls the pharmacy to find out which prescription from a therapeutic category will be the most cost-effective for the patient.
Incorrect NDC or NPI Billed? Humana Requires Corrections
Humana has recently sent out another round of audits where either an incorrect NDC number or National Provider Identifier (NPI) was billed.
At Your Own Risk: “Use as Directed”
How many times have you received a prescription for a bowel prep, starter pack, or pre-packaged taper where the directions simply state, “Use as Directed?”
Off-Label Use Beyond GLP-1
GLP-1 medications being used off-label for weight loss, and the corresponding audit risk, has been a hot topic for awhile now, but there are other medications that PAAS National® frequently sees recoupments for when being used off-label, especially when billed to a Medicare plan.
Insurance Limits Quantity – Common Scenarios and Pitfalls
When processing prescriptions, insurance companies require pharmacies to bill an accurate days’ supply derived from mathematical calculations obtained from the directions.
Quantity Changes Cause Audit Appeal Trouble
PAAS National® is seeing more discrepancies for “unauthorized” refills on audits and PBMs continue to make these discrepancies difficult to appeal.
Best Practices: Medication Delivery
With the Public Health Emergency (PHE) for COVID-19 ending May 11, 2023, a return to pre-pandemic requirements for proving patient receipt of medications is anticipated.
