Common Claim Denials for Medicare Part B
Many of the denied claims are due to not meeting medical necessity, frequency limitations, lacking supporting medical records and even basic coding mistakes.
Entries by Jennifer Ottman, CPhT
Would Your Spravato® Documentation PAAS an Audit?
Spravato® is a Schedule III controlled substance intranasal spray used in conjunction with an oral antidepressant for treatment-resistant depression in adults
Beware: Same Ingredients, Different FDA Indications
Ozempic® is an injectable diabetic medicine used to improve glycemic control in adults for type 2 diabetes management
Self-Audit Series #6: Transfer Prescriptions
Transferred prescriptions are at high risk for audit recoupment. The PBMs are hitting pharmacies on incomplete transferred prescriptions based on missing required elements.
COVID-19 Vaccine Billing Guidance (April Update)
PAAS National® has seen a few COVID-19 vaccine audits since pharmacies began billing and administering within the last few months. This article contains some reminders and updates from our January 2021 Newsline COVID-19 Vaccine Billing Guidance.
PBM Enforcement of Return to Stock Policies
A PBM will recoup a claim in full if a medication is picked up after their required return to stock timeframes listed in the respective provider manuals.
COVID-19 Vaccine: Are You Prepared to Administer?
Healthcare providers will play a key role when a COVID-19 vaccine becomes available.
Foot Bath Prescriptions – MedImpact is Now the Fifth PBM Investigating
PAAS National® has alerted members through several Newsline articles of an increase in audits with Prime Therapeutics®, Caremark®, OptumRx® and Express Scripts® investigating foot bath prescriptions.
Ozempic®– Bill It Right!
Ozempic® is an injectable used to improve glycemic control in adults with type 2 diabetes mellitus and is available as 2 mg in a 1.5 mL (1.34 mg/mL) pre-filled, disposable pen injector.
PBMs Require “Cut Quantity” Documentation
Whenever a pharmacy dispenses a quantity less than what the prescriber ordered, there should be a reason documented for the “cut quantity”.
