Beware: Caremark is Monitoring High Quantity Utilization and Atypical Dispensing Habits
Beyond traditional desktop, on-site, investigational or invoice audits, Caremark performs various compliance reviews.
Entries by Jennifer Ottman, CPhT
Update: Medicare Part D Mandatory E-Prescribing Requirements for Controlled Substances – Final Rule
PAAS National® alerted pharmacies to the delay in enforcement of Electronic Prescribing for Controlled Substances (EPCS) for Medicare Part D until January 1, 2023.
DMEPOS Mini-Series #8 – The Six Medicare Auditing Entities and Their Purpose
The six Medicare auditing entities are responsible for auditing records, claims and payments. What is the rationale for having these auditing entities?
Be on the Lookout for OptumRx Unannounced Onsite Audits
Being prepared for an unannounced audit is crucial and PAAS National® wants to make sure you have the tools to be successful.
NCPDP Modified Section 11.15 of the Emergency Preparedness Guidance Document – COVID-19 Oral Antivirals Billing
PAAS would like to point out some of the updates and additions to section 11.15 of the document Billing of a Self-Administered Free COVID-19 Oral Antiviral During an Emergency.
DMEPOS Mini-Series #7 – Immunosuppressive Drugs for Transplant
This month, we continue with our DMEPOS mini-series by discussing yet another challenging category – immunosuppressive drugs for a transplant. Immunosuppressive drugs are only covered under Part B to maintain an organ transplant that was Medicare eligible.
Are You Prepared for an OTC COVID-19 Test Audit?
Billing and dispensing OTC COVID-19 tests is widespread throughout community pharmacies.
DMEPOS Mini-Series #6 – Therapeutic Shoes for Diabetes
Every 17 seconds someone is diagnosed. Noridian, Jurisdiction D, has been conducting Targeted Probe and Educate reviews of HCPCS code A5500, which is for therapeutic shoes.
DMEPOS Mini-Series #5 – Surgical Dressings
Use these helpful tips and links to be prepared in case of an audit on surgical dressings.
Trudhesa™ Nasal Spray for the Treatment of Migraines
Migraine relief medications are frequently monitored and flagged for audit due to high cost, quantities submitted, days’ supply and/or frequency of refills.
