PAAS National® has recently seen a new trend with investigational audits completed by PerformRxSM. These audits are a combination of an invoice, desk, and a compliance audit. Pharmacies must obtain invoices for the requested date range, 25-60 prescriptions, signature logs and proof of copay collection for all refills.
This investigational audit also includes an extensive questionnaire. The questionnaire may have unique questions based on idiosyncrasies the PBM has identified for your pharmacy. Mailing and delivery procedures and automatic refill policies are just some of the questions pharmacies must address.
We urge pharmacies to review their written Standard Operating Procedures (SOP) and Fraud, Waste, & Abuse Compliance Programs. Updates may be necessary to ensure your policies and procedures are compliant with current practice. The Onsite Credentialing Guidelines we have created is an excellent tool to prepare you for common questions PBMs may ask.
Remember to engage PAAS analysts early to ensure you have the most successful outcome.
- Review the following Newsline articles for additional tips:
- January 2022, Self-Audit Series #12: Invoice Audits
- February 2023, Are Your Delivery/Signature Logs PBM Compliant for 2023?
- March 2023, Proof of Copay Collection-Secondary Payers Hidden in Plain Sight
- September 2022, Automatic Mailing for Part D Patients
Looking for an FWA/HIPAA Compliance program? Schedule a service overview with PAAS National® today and learn how to get started on customizing your Policy and Procedure Manual.