Why Does Billing the Correct Origin Code Matter?
Pharmacies are required to enter an origin code on claims to indicate where the prescription came from or “originated.”
Entries by Jenevra Azzopardi, CPhT
Valid Prescriber/Patient Relationships and Marketing Concerns
With the U.S. Department of Health and Human Services Office of Inspector General’s (OIG) recent focus on telemedicine fraud, pharmacies may be wondering what their obligations are when determining a prescription’s authenticity – especially when it comes to whether a valid prescriber/patient relationship exists.
The Ballad of Snowbirds and Audits
The winter months have many pharmacies mailing prescriptions to their snowbird patients who leave their northern nests for more hospitable climates.
What Do Bowel Preps, EpiPen®, and Migraine Medications Have in Common?
Prescriptions for medications whose dosing is standardized in the industry often come with directions that simply state, “Use as directed.”
OIG Telehealth Fraud Concerns
In September 2022, the U.S. Department of Health and Human Services Office of Inspector General (OIG) put out a report on program integrity risks concerning Medicare telehealth services during the first year of the COVID-19 pandemic.
How Can I Avoid Humana Audits for Deceased Patients?
Humana has recently sent out audits to pharmacies with a subject line stating Review of claim(s) billed after member’s deceased date.
Bill It Right – Diazepam Gel
Diazepam rectal gel continues to confuse prescribers and pharmacies alike when it comes to how a prescription is written and then ultimately filled and billed.
Prescription Quantity Changes Require Documentation
Anytime you dispense a quantity different from what was prescribed, you should note why.
Combivent® Respimat® Still Causing Confusion
The new inhaler was not an exact replacement of the old one. What happens if the plan will not allow a 20-day supply?
Be Audit Ready! Clinical Notes and Annotations: What Documentation is Essential for Audit?
Make sure you have good documentation of the conversation with the prescriber’s office to successfully pass an audit that may occur years later.
