Entries by Jennifer Ottman, CPhT

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.

COVID-19 Vaccine Billing Guidance (April Update)

PAAS National® has seen a few COVID-19 vaccine audits since pharmacies began billing and administering within the last few months. This article contains some reminders and updates from our January 2021 Newsline COVID-19 Vaccine Billing Guidance.

PBM Enforcement of Return to Stock Policies

A PBM will recoup a claim in full if a medication is picked up after their required return to stock timeframes listed in the respective provider manuals.

Ozempic®– Bill It Right!

Ozempic® is an injectable used to improve glycemic control in adults with type 2 diabetes mellitus and is available as 2 mg in a 1.5 mL (1.34 mg/mL) pre-filled, disposable pen injector.