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 […]
It is no secret that margins are thin and pharmacies have been looking for additional revenue-generating opportunities. Some pharmacies have added immunization services, performed billable Medication Therapy Management, added Point of Care Testing, and/or found other non-PBM income sources to offset low (or negative) reimbursements from third-party payors. These services are patient-focused and can increase […]
Sir Francis Bacon is often credited with stating “scientia potentia est” in his published work, Meditationes Sacrae from 1597. This Latin phrase roughly translates to “knowledge is power” and while this turn of phrase is centuries old, it holds true today. The pharmacy industry is an ever-changing world and staying up to date on audit […]
If your pharmacy dispenses rapid-acting insulin, be ready to start closely evaluating the patient’s method of administration. Knowing whether a patient is using the rapid-acting insulin for direct injection (via syringe or pre-filled pen), with a disposable insulin pump, or in a qualifying DME pump will become critical to claim payment starting in October.
In last month’s Newsline article, “A” for Abandoned: The Short Life of DAW Code A and What it Means for Multi-Payor Claims, PAAS National®® provided insight into the revised billing process for multi-payor claims where one payor prefers the brand and the other payor prefers generic. Due to the complexity of this billing process, a […]
To enhance profitability, pharmacy owners and operators have frequently incorporated immunization services into their offerings. While vaccines tend to carry a lower audit risk, the higher the cost of the vaccine, the more likely it is to be audited. The audit risk also increases when core billing elements of the vaccine claim are adjudicated incorrectly.
Just 11 short months ago, PAAS National®® released the NEW Dispense As Written (DAW) Code Revealed Newsline article about DAW code value “A” (408-D8). DAW A was designed to be utilized on multi-payor claims when one payor required a multi-source brand (or reference biologic with an approved interchangeable biosimilar in the marketplace) and the other […]
Undoubtedly, a calculator can be found near every data entry and verification station throughout the prescription workflow line. This is, in part, due to PBM requirements that prescriptions have a mathematically calculable set of instructions. Consequently, pharmacies should strive to bill every claim with an appropriate quantity and days’ supply to prevent claim recoupment issues […]
