Entries by Jennifer Ottman, CPhT

Billing the Correct Insulin for Use in a Pump

Insulin is a very popular audited drug category due to its complexity, frequency of use, and high cost. When used in conjunction with an insulin pump, it adds another layer of complexity.

Self-Audit Series #14: DMEPOS Items

Medicare Part B/DMEPOS billing and documentation rules are VERY different from most of your pharmacy claims – if you don’t have a strong grasp of these differences, or a process for handling the documentation, then you are sure to experience significant problems. 

Self-Audit Series #13: Diabetic Test Strips

Due to the high volume of claims for diabetic test strips, they continue to receive significant attention during third-party audits. Follow the tips below to be prepared if you get an audit.

Self-Audit Series #12: Invoice Audits

PBMs have dramatically increased the number of invoice audits conducted and some pharmacies continue to be at risk for significant financial recoupments and contract terminations.

Common Claim Denials for Medicare Part B

Many of the denied claims are due to not meeting medical necessity, frequency limitations, lacking supporting medical records and even basic coding mistakes.

Self-Audit Series #6: Transfer Prescriptions

Transferred prescriptions are at high risk for audit recoupment. The PBMs are hitting pharmacies on incomplete transferred prescriptions based on missing required elements.