Estrace® and Premarin® vaginal creams continue to be audit targets because they are often found to be billed incorrectly. A recovery on one claim billed with a wrong days’ supply often causes subsequent refills to be recouped for being ‘refilled too soon’. To prevent this claim recoupment…
The most recent Office for Civil Rights (OCR) Cybersecurity Newsletter was released in January and focuses on system hardening and protecting electronic PHI (ePHI). “System hardening is the process of customizing electronic information systems (e.g., computer systems and other electronic devices) to reduce their attack surface, thus reducing the number of weaknesses and vulnerabilities that […]
CVS Caremark updates, and mails, their complete provider manual in a hardcopy version to member pharmacies every other year, on even years. Pharmacies should have received a printed copy of the 2026 Caremark Provider Manual towards the end of last year. Undoubtedly due to congressional pressure, and as discussed in this month’s feature Newsline article: […]
PAAS National®® continuously monitors legislative and regulatory changes that may impact your Fraud, Waste & Abuse and HIPAA Compliance Program. We keep a close eye on enforcement from the Department of Justice, Office of Inspector General, State Attorney Generals, and Office for Civil Rights to help ensure the program meets interpretative standards. Furthermore, PAAS works […]
Antifungal nail treatments remain a high audit target. If the pharmacy is dispensing Jublia® (efinaconazole), ciclopirox (formerly Penlac®), or tavaborole (formerly Kerydin®), you can almost guarantee you’ll see that claim show up on an audit. Auditors love these medications because if the prescription does not clearly indicate…
What is significant about March 1, 2026? According to the website Days Of The Year, it is National Barista Day, Share a Smile Day, and Endometriosis Awareness Day. While these are all great causes, the date carries additional significance for any covered entity (e.g., a pharmacy) who had a HIPAA breach of less than 500 […]
Recently, PAAS National®® analysts have been assisting pharmacies with Targeted Probe and Educate (TPE) audits from CGS, the DME Medicare Administrative Contractor (MAC) for Jurisdictions B and C. Per CGS, “The purpose of the claim review is to ensure documentation supports the reasonable and necessary criteria of the services billed and follows Medicare rules and […]
In a perfect world, all prescriptions received by your pharmacy would be 100% accurate with no need to follow up with the prescriber for clarification. Since we do not live in that utopian paradise, it is a common occurrence that prescriptions come over with invalid or non-specific quantities, incomplete or unclear directions, or other errors […]
As the year winds down, it is important to verify that all staff have completed their required training. Once the clock strikes midnight on December 31st, all 2025 training requirements must be completed. If the pharmacy has staff who have not completed their training by this deadline, the pharmacy will be considered non-compliant with CMS […]
Vaccine season is upon us! Pharmacies who offer immunization services are likely seeing an influx in requests for seasonal influenza, COVID-19, and other routine vaccines. However, it is important to take a step back and evaluate exactly which vaccines you are formally allowed to authorize and administer, especially after the meeting of the Advisory Committee […]
