Small Differences Between Prescription Directions and Patient Label Can Lead to BIG Recoupments
PAAS National® recommends attention to detail when it comes to typing directions for patient labels.
Entries by Jenevra Azzopardi, CPhT
Off-Label Use Not Covered Under Medicare Part D
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).”
Manipulating Quantity or Days’ Supply to Bypass Plan Limits Will Cost You
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.
Centene® – Why Are They Leaving the PBM Game?
At the end of October 2021, Centene® executives said the company would be making a $30 billion request for proposals from outside contractors to take over the pharmacy benefit manager (PBM) side of their business. The request for proposal is expected to launch in 2022 and be awarded in 2023.
Telemedicine Audits: Are Your Prescriptions Legitimate?
Unfortunately, telemedicine also continues to be an easy target for bad actors, with pharmacies being caught in the middle.
Mid-Level Practitioners and Their Supervising Physicians– Documentation Required?
PAAS National® has seen a recent uptick in the number of prescriptions being found discrepant for missing the supervising physician when written by a mid-level practitioner (e.g. physician assistant or nurse practitioner).
