As of January 15, 2022, pharmacies are capable of billing up to eight at-home COVID-19 tests per covered individual per month.
About Meredith Thiede, PharmD
Independent pharmacy is in my blood. Both my great-grandfather and grandfather owned Rexall stores in northern Wisconsin. I always had the dream of owning my own independent pharmacy (with my very own soda fountain!), but I have quickly found being part of your independent pharmacy’s success story is even more rewarding for me. I look forward to being part of the trusted PAAS team that helps you navigate the waters of the ever-changing world of pharmacy audits and Fraud, Waste, and Abuse regulations.
Entries by Meredith Thiede, PharmD
The Valeritas V-Go® Insulin Delivery Device (V-Go®), a disposable insulin delivery device, can be challenging to bill properly.
Pharmacy Benefit Managers (PBMs) update their provider manuals on occasion (some more frequently than others) and although the changes are applicable to the practice of all pharmacies contracted with that PBM, it can be difficult to keep track of the method by which each PBM updates their manual and where to find it.
As reported in a September 27, 2021 article by the US Attorney’s Office, the owner of a pharmacy in Juana Díaz, Puerto Rico, “knowingly and willfully” administered vaccine outside of the Emergency Use Authorization (EUA) and subsequently billed Medicaid for the claims. Twenty-four children between 7-11 years of age were vaccinated with the Pfizer-BioNTech COVID-19 vaccine.
With additional doses of the COVID-19 vaccine being approved comes additional opportunities for COVID-19 audits, particularly in the realm of vaccine administration to Medicare beneficiaries at their homes and to the immunocompromised patient population.
On July 1, 2021 Humana updated three audit program documents and published them on their public pharmacy resources page under the “Manuals and forms: Audit guide, claim form and other materials” tab section.
Test strip manufacturers sit in a unique position when it comes to monitoring nonprescription diabetic supply purchasing and dispensing. Manufacturers acquire purchase histories from authorized distributors regarding the volume of test strip products ordered by a pharmacy.
Safeguarding patient’s electronic PHI (ePHI) is a top priority for all who work in healthcare. Unfortunately, tactics hackers use to access ePHI have become more sophisticated and occur with an increasing frequency.
According to the Office for Civil Rights (OCR), the Privacy Rule allows for pharmacies to disclose PHI about a deceased patient to person(s) involved in the individual’s health care prior to their death, unless doing so is going against the patient’s documented requests.