Insufficient/Missing Clinical Notes Yield Audit Recoupments
PAAS National® analysts are seeing more prescriptions flagged for recoupment when insufficient or missing information is not verified with a valid clinical note.
Entries by Jennifer Ottman, CPhT
Biosimilar Advancements: Understanding the Latest Updates on Humira® with Cyltezo® and Abrilada™
At the time our April 2023 Newsline article Biosimilar Adoption for Humira® in 2023 was published, eight FDA biosimilars for Humira had been approved, and five more were pending approval.
$32 Million Kickback Scheme Involving Medicare and TRICARE
According to an August 18, 2023 press release from the U.S. Attorney’s Office, District of New Jersey, a former president of a pharmacy business pleaded guilty to a scheme that violated the Federal Anti-Kickback statute.
Breyna™ – The First FDA Approved Symbicort® Generic With a 0.1 Gram Problem
Breyna™, like Symbicort® is approved as a maintenance therapy for people with COPD and for asthma patients ages 6 and older.
PAAS Defends Community Pharmacies by Engaging DME Medicare Administrative Contractor CGS
In our August Newsline Standard Written Order and Medicare Part B Audit Risks – New Guidance, we shared a few examples some of our members are having on audit results regarding their Standard Written Order (SWO). Beyond writing the Newsline, PAAS National® also reached out and engaged nurse medical reviewers with CGS about our concerns on the three topics below.
Best Practices for Billing Vaginal Creams to Avoid Recoupment
PAAS National® analysts frequently receive questions regarding the proper billing of creams and ointments, an easy audit target for PBMs.
Migraine Medications Continue to Cause Headaches
As PBMs continue to monitor claims for migraine medications, PAAS National® continues to receive questions about billing and the audit risks associated with these claims.
Standard Written Order and Medicare Part B Audit Risks – New Guidance
If you are a Medicare Part B provider, then you know how cumbersome a Medicare Part B audit can be. For most Medicare Part B audits, a pharmacy would be required to provide a valid Standard Written Order (SWO), medical records to support the diagnosis and continued need of the item, proof of delivery, and proof of refill request if mailing or delivering supplies.
Seeing Too Many or Repeated Prescription Validation Requests – Take Action!
See the PAAS tips for best practices on how to track and manage duplicate or high numbers of prescription validation requests.
PBM Communications to Network Pharmacies Can Help Prevent an Audit!
PAAS National® knows community pharmacies are busier than ever, making it difficult to keep up with all the PBM communications.
