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.
Humana has recently sent out audits to pharmacies with a subject line stating Review of claim(s) billed after member’s deceased date.
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.
Anytime you dispense a quantity different from what was prescribed, you should note why.
The new inhaler was not an exact replacement of the old one. What happens if the plan will not allow a 20-day supply?
Make sure you have good documentation of the conversation with the prescriber’s office to successfully pass an audit that may occur years later.
This partnership was designed to allow both companies to operate independently with ESI providing services to Prime, including performing some audits.
PAAS National® recommends attention to detail when it comes to typing directions for patient labels.
PAAS National® has seen an increase in audit results from Elixir where the pharmacy was cited for “Claim not covered under Medicare Part D (NPD).”
Plan limit rejections are intended to help control costs, provide clinical edits, and assist pharmacies in ensuring patient safety. When an initial claim adjudication is rejected for exceeding plan limits (e.g., Max Quantity Limit or Quantity vs Time Limit), pharmacies need to proceed with caution.
