Proof of Copay Collection – Secondary Payers Hidden in Plain Sight
If your pharmacy has not had to deal with proof of copay collection on an audit, your time is coming.
Entries by Sara Hathaway, PharmD
To Sign, or Not to Sign, the OptumRx® Recoupment Waiver … That Is the Question
If your pharmacy has recently been through an OptumRx® desk audit, you may have come across the OptumRx Provider Intent Form – Recoupment Waiver.
Process for Dealing with a Patient HIPAA Complaint
Anyone can file a complaint if they feel their rights under the HIPAA Privacy, Security, or Breach Rules have been violated.
Multi-Language Insert Must Be Provided to Medicare Beneficiaries as of January 1, 2023
After reading this article you should understand what a multi-language insert is, why it must be provided, and when you are required to hand it out.
Criminal HIPAA Charges Filed Against Compounding Pharmacy Sales Rep
Criminal HIPAA charges are not handed down frequently, but when an individual “knowingly” and inappropriately obtains and discloses a patient’s protected health information (PHI), they could face up to $50,000 in fines and up to one year in prison.
Beware of the New Problem with the Updated Online Santyl® Calculator
Santyl® ointment 250 units/gram is a topical medication indicated for debriding chronic dermal ulcers and severely burned areas.
Yes, LTC Delivery Manifests ARE Needed!
PAAS National® analysts often see LTC pharmacies struggle with providing sufficient documentation to satisfy proof of dispensing for an audit.
Three Common Pitfalls to Avoid When Billing Oral Inhalers
Oral inhalers remain a high audit risk for all PBMs and being able to identify billing pitfalls may mean the difference between a claim safe from recoupment and one lost due to an improper DAW code, early refill, or overbilled quantity.
Are You Utilizing DAW Codes Correctly? Updated Tool Available!
Though the definitions were revised to include biologic drug products, the guidance holds true for all legend drugs. Now is the time to refamiliarize yourself with the best-practices for using DAW codes and to review DAW code audit pitfalls most seen by PAAS National® analysts.
