How Can I Avoid Humana Audits for Deceased Patients?

Humana has recently sent out audits to pharmacies with a subject line stating Review of claim(s) billed after member’s deceased date. This review is taking place, sometimes more than a year after the date of service, because some Medicare Part D claims were paid after a beneficiary passed away. Why would Humana wait so long to review these claims, and why did they not stop them at point of sale? Unfortunately, there is usually significant lag time from when a patient passes away to when this information is reported to the Social Security Administration, and then to CMS and Plan Sponsors.

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To combat these recoupments, pharmacies are allowed to submit documentation to demonstrate the claim was billed appropriately. If the date of service is within 14 days from the deceased date for retail claims, or within 32 days from the deceased date for long-term care claims, a pharmacy can send signed proof of delivery or a signature log showing someone received the medication on the patient’s behalf. If the deceased date is incorrect on Humana’s records, an obituary showing the correct date of death can be sent.

There are some things you can do to help avoid these situations to begin with.

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Jenevra Azzopardi, CPhT