How much rounding can one get away with?

[ArtificallyFlavored]

Does anyone work for insurance? What if I rounded a Novolog box from 31 days supply to 30 days, will that be charged back during an audit? Is there even a set number days we can round before insurance takes it back?

---

Members don't see this ad.

 

[ldiot]

I can't answer your question but I'm told to follow this line of thinking... Calculate the exact day supply. So say 1 box of novolog pens will last for 50.5 days. I round down and use 50 days as the day supply. If the insurance rejects and states that they only cover 30 day supply, then I bill 1 box as a 30 day supply. They can't charge back because you can't dispense a quantity less than one whole box (though some places do but that's a different argument). If they only cover a 90 days supply then you need a new script.

For flonase and rescue inhalers I don't calculate anything and just put 30 days for everything. I've never seen someone run out before insurance would cover it using this rule but if the directions are less than a potential of 7 puffs a day you could technically run into issues because the actual day supply would be greater than 30 days. That being said, a lot of plans only cover 30 day supply anyways so I'm not sure it's even worth calculating.

I'm not a pharmacist but I can imagine verifying these scripts is annoying. Did the tech put 30 days because the insurance requires a 30 day supply or did they put 30 days because they didn't calculate it? You can't possibly be checking this for every script... I think the only thing you can do is verify it and make sure your techs go about it correctly?

 

[confettiflyer]

Lol I thought this was going to be a complaint about patient rounding in a hospital or something

 

[Sine Cura]

II'm not a pharmacist but I can imagine verifying these scripts is annoying. Did the tech put 30 days because the insurance requires a 30 day supply or did they put 30 days because they didn't calculate it? You can't possibly be checking this for every script... I think the only thing you can do is verify it and make sure your techs go about it correctly?

Yes you should because it's a waste of time to rebill an old fill to get the new fill to go through (yes even for rescue inhalers).

 

[fcrc]

Considering a loss of liquid when priming and accounting for patient error, a couple days seems to be okay. But if it's 10 days or more difference--i.e. the insurance is forcing 30 days supply but you're actually giving a 40 days supply--it's perfectly fine to bill for the 30 days but you have to make sure you don't refill till about 37 days out, not 27 days out.

 

[ldiot]

Yes you should because it's a waste of time to rebill an old fill to get the new fill to go through (yes even for rescue inhalers).

I agree with the point you are making; I've just never had this problem using 30 days for rescue inhalers.

 

[Ackj]

I agree with the point you are making; I've just never had this problem using 30 days for rescue inhalers.

Theoretically, many of them are written to be 16.67 or 25 days (1-2 puffs q 4-6h prn). Real world, you've got some problems if you need to use it that much and you're probably going to be getting a change in therapy.

 

[zelman]

I agree with the point you are making; I've just never had this problem using 30 days for rescue inhalers.

Do you not have medicaid patients who fill proair every 14 days in order to share with their illegal immigrant family members? Guess my stores are weird.

 

[ldiot]

Do you not have medicaid patients who fill proair every 14 days in order to share with their illegal immigrant family members? Guess my stores are weird.

Ours put everything on auto fill and pick them up when their Xanax is due.

 

[BidingMyTime]

Lol I thought this was going to be a complaint about patient rounding in a hospital or something

Yeah, I was thinking, why would rounding be a problem, I think we are long past the days where doctors would frown at pharmacists rounding.

 

[boriqua]

i would think the insurance would be too busy auditting the invoices for the 20 atriplas you billed where you only ordered 12 from your manufacturer and the rest you brought off the street. never had an insurance chargeback something because the days supply was a few off.