Billing OTC COVID-19 Tests Brings New Struggles and Opportunities
As of January 15, 2022, pharmacies are capable of billing up to eight at-home COVID-19 tests per covered individual per month.
Entries by Meredith Thiede, PharmD
Bill It Right: V-Go® Insulin Delivery Device and Rapid Acting Insulin Vials
The Valeritas V-Go® Insulin Delivery Device (V-Go®), a disposable insulin delivery device, can be challenging to bill properly.
PBM Provider Manual Updates – What You Need to Know
Pharmacy Benefit Managers (PBMs) update their provider manuals on occasion (some more frequently than others) and although the changes are applicable to the practice of all pharmacies contracted with that PBM, it can be difficult to keep track of the method by which each PBM updates their manual and where to find it.
Vaccinating Outside of Approved COVID-19 Emergency Use Authorization Has Legal Ramifications
As reported in a September 27, 2021 article by the US Attorney’s Office, the owner of a pharmacy in Juana Díaz, Puerto Rico, “knowingly and willfully” administered vaccine outside of the Emergency Use Authorization (EUA) and subsequently billed Medicaid for the claims. Twenty-four children between 7-11 years of age were vaccinated with the Pfizer-BioNTech COVID-19 vaccine.
COVID-19 Vaccine Administration Audit Risk (including New PAAS Resource)
With additional doses of the COVID-19 vaccine being approved comes additional opportunities for COVID-19 audits, particularly in the realm of vaccine administration to Medicare beneficiaries at their homes and to the immunocompromised patient population.
Humana Audit Program Updates
On July 1, 2021 Humana updated three audit program documents and published them on their public pharmacy resources page under the “Manuals and forms: Audit guide, claim form and other materials” tab section.
LifeScan Hires Law Firm to Pursue Pharmacies Purchasing from Unauthorized Distributors
Test strip manufacturers sit in a unique position when it comes to monitoring nonprescription diabetic supply purchasing and dispensing. Manufacturers acquire purchase histories from authorized distributors regarding the volume of test strip products ordered by a pharmacy.
Safeguarding ePHI – Office for Civil Rights (OCR) Summer Update
Safeguarding patient’s electronic PHI (ePHI) is a top priority for all who work in healthcare. Unfortunately, tactics hackers use to access ePHI have become more sophisticated and occur with an increasing frequency.
PHI Access and Release for Deceased Patients
According to the Office for Civil Rights (OCR), the Privacy Rule allows for pharmacies to disclose PHI about a deceased patient to person(s) involved in the individual’s health care prior to their death, unless doing so is going against the patient’s documented requests.
