Appropriate Billing for CeQur SimplicityTM Patch and Insulin
Use the following information when billing CeQur Simplicity TM patches and the rapid-acting insulin used within the patch to decrease your risk of recoupment upon audit.
Entries by Sara Hathaway, PharmD
Insulin For a Pump: The Recoupment You Never Saw Coming
There are many billing pitfalls related to insulin claims, which is why auditors love to target them. The claim can face recoupment for a missing or incorrect strength, formulation, substitution, days’ supply calculation and so on, but one recoupment many pharmacies never see coming is insulin for a pump being inappropriately billed.
HIPAA Breach Notification Letter Sent to 82,466 Patients Due to Improperly Shared Data
According to the U.S. Department of Health and Human Services breach portal, the mail-order pharmacy Healthy Options dba Kroger Postal Prescription Services (PPS) reported a breach of information which affected 82,466 patients.
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.
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.
