OptumRx® Provider Manual Updates May Shift Audits – Especially LTC
OptumRx® updates their Provider Manual several times throughout the year and publishes the full version on its publicly available webpage.
Entries by Sara Hathaway, PharmD
Scare Away the Unwanted: Four Facility Access Controls You Need!
Safeguarding the pharmacy’s Protected Health Information (PHI) is critical.
What FWA and HIPAA Compliance Elements are Necessary for Interns, Job Shadows, Floating Staff, Cashiers and Delivery Drivers?
Safeguarding the pharmacy’s Protected Health Information (PHI) is a MUST for all staff expected to come in contact with this sensitive information.
Drug Substitution Questions: Januvia®, Zituvio® and sitagliptin
PAAS National® analysts are receiving numerous inquiries regarding the substitution of Januvia®, Zituvio® and sitagliptin.
The Double Threat: Ransomware Attack Followed by HIPAA Non-Compliance Settlement
Imagine getting a papercut then moments later, cleansing your hands with alcohol hand sanitizer—you can almost feel the instantaneous sting the alcohol causes in the fresh wound. Not only are you subjected to the initial affliction, but also the second round of pain from the alcohol in the wound.
Do The Math and Avoid the Recoupment
Proper mathematical calculations are critical to billing prescriptions correctly. The action of translating directions on the prescription into a mathematical equation seems simple, but PAAS National® analysts see claims billed with incorrect days’ supply every day!
NEW Dispense as Written (DAW) Code Revealed
Chances are you have come across a claim or two (or several thousand!) with a DAW code of 1, 2, or 9. Pharmacy staff are usually knowledgeable about when to use these DAW codes – that a DAW 1 may be appropriate to use when the prescriber does not authorize generic substitution on a multi-source brand, a DAW 2 when the patient requested the brand name, and a DAW 9 when the plan explicitly indicates the brand name product is preferred.
Auditors Are Drawn to Santyl® Like Moths to a Flame
Summer is here and so are the bugs! While mosquitos, gnats, moths and the like have next to nothing to do with Santyl® ointment for debriding chronic dermal ulcers and severely burned areas, the visualization of auditors being drawn to claims for Santyl® ointment being akin to moths (or other bugs) being drawn to a flame is a parallel not to be ignored.
Independent Pharmacies are NOT Safe from Cyberattacks
Have you ever had your credit card stolen, lost your wallet, or misplaced your social security card?
Why You Should Care About PBM Provider Manuals (and Where to Find Them)
Whether your pharmacy contracts directly with a PBM or the agreements are negotiated through a Pharmacy Services Administrative Organization (PSAO), the terms and conditions within the agreements are just the beginning of a pharmacy’s obligations.
