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 […]
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 […]
