PAAS National® has created an Onsite Credentialing Guidelines, an extensive checklist to assist PAAS members with scheduled and/or unexpected visits from PBM auditors. Unannounced visits can catch pharmacy staff off guard when the Pharmacist-in-Charge (PIC) is not present.
PAAS National® analysts receive numerous calls at the start of the new year looking for guidance on opioid plan rejects.
Appealing audit discrepancies can be confusing and time consuming. PAAS National® analysts have over 50 years of dedicated audit assistance experience, and review nearly 10,000 audits a year.
Many pharmacy teams are overwhelmed with the increasing daily workload. This can result in data entry staff creating shortcuts, like entering override codes to get claims processed.
Audit results flagging “unauthorized refills” or “overbilled quantity,” can lead to big recoupments.
COVID-19 has forced a significant increase in the number of vaccinations pharmacies do daily. With this increase also comes additional audits.
PAAS National® analysts continue to see claims for Premarin® and Estrace® creams being audited and recouped. Are you in jeopardy?
Pharmacies are often startled with the limited amount of time a PBM offers prior to an onsite audit. However, PBM auditors, DEA agents, FDA inspectors and state Board of Pharmacy inspectors can also make unannounced visits.
Pharmacies updating or changing their dispensing platform may face unique audit issues.
Dispensing OTC COVID-19 tests is widespread through community pharmacies. Pharmacies must be aware that submitting claims to PBMs for these tests opens the window for auditing. Ensuring you have procedures in place to accurately purchase, bill and dispense these home tests is imperative. While the dollar amount of these claims does not seem audit worthy, PBMs will be checking for Fraud, Waste and Abuse and contract violations.
