PAAS National®® analysts continue to see unbreakable packages on audits causing recoupment due to dispensing quantity and days’ supply issues. Below is a list of common scenarios: Pharmacies should always …
PBMs and audit companies pay close attention to how pharmacies bill claims, including which DAW code was used. This seemingly innocent billing element can cause significant audit issues if not used properly. Any DAW (other than 0) should have supporting documentation for why it was appropriate to use. PBMs will continue to pay close attention […]
Filing and billing claims involves keeping track of what can feel like an endless number of details. The fast-paced environment of the pharmacy doesn’t always allow for keeping tedious details at the forefront of your mind. Below you’ll find a guide detailing common scenarios that should be considered while filling prescriptions to reduce your audit […]
CMS Form 10882 is a Medicare notice that Plan Sponsors (via CMS directive) require pharmacies to provide to patients if a prescription copay for a Medicare Part D claim exceeds $600. This distribution requirement started January 1, 2025, and is prompted by an Approval Message Code 056. The expiration date on the current version of […]
Abbott has announced that the FreeStyle Libre 2 and FreeStyle Libre 3 sensors will no longer be available after September 30, 2025. Patients that are currently filling prescriptions for these products will need to obtain new prescriptions for the FreeStyle Libre 2 Plus or FreeStyle Libre 3 Plus sensors. FreeStyle Libre 2 Plus sensors can […]
PAAS National®® receives many questions about topical prescriptions, including more complicated products like foam dosage form medications. These products often come in pressurized aluminum cans without a clear way of measuring the product when dispensing. In addition to this issue, prescribers often send prescriptions to the pharmacy with a vague set of instructions. PBMs are […]
We are living in unprecedented times as the Justice Department announced the outcome of their 2025 National Health Care Fraud Takedown, marking one of the largest enforcement actions of its kind. Criminal charges were filed against 324 individuals, from various health care professions, for their alleged participation in a range of fraud schemes. The total […]
We’ve all been in the sticky situation of having a few straggling pills left associated with one NDC that would be ideal to get off the shelf and free up some space. Maybe this NDC used to be the preferred product and now it has changed, or the manufacturer was bought out by another company. […]
OptumRx® continues to maximize chargebacks on pharmacies due to days’ supply errors. It’s important to take the extra time to confirm billing elements are accurate prior to adjudicating – this could save you on the back end of an audit.
Medication synchronization (med sync) programs are common across pharmacies and yield many benefits. Patients can request it to manage medication better and reduce the number of trips needed to the pharmacy. Patient adherence increases and pharmacies can keep tighter control over inventory while having more efficient workflow. NCPA promotes the improved adherence and quality of […]
