2 damn audits in 2 days??

[Doctor M]

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We got a fax on 1/24/12 of an audit by Catalyst Rx for 2/21/12 and 1 week before that we received a letter of intent to audit on site for 2/23/12 from prescription solutions. WTF???? 2 audits in 2 days? We all know what these auditors do. My 2 days are gonna be hell. We also got a desk audit from Cigna and Humana a few weeks ago. WTF?? We were also audited in September 2011 by Caremark. Damn!!😕😕😕😕😕😕😕😕

 

[Its Z]

Audits and surveys will get worse. we had a cms & cdph audit back to back. and oig is auditing our charges for expensive chemos....continuously. they are trying to recoup every cent they can.

 

[Doctor M]

Audits and surveys will get worse. we had a cms & cdph audit back to back. and oig is auditing our charges for expensive chemos....continuously. they are trying to recoup every cent they can.

I can see auditing to look for abuse or fraud, that is fine with me, but these people look for typographical errors, clerical, wrong NDC's, BS like that.

 

[Its Z]

I can see auditing to look for abuse or fraud, that is fine with me, but these people look for typographical errors, clerical, wrong NDC's, BS like that.

They aint looking for frauds and abuse like they used to. theyre looking for waste dochments ....purchase data for correct size vials etc. its pretty bad.

 

[kvl1027]

Its getting bad, we are writing a check to Prime for over $8K for some Migranol we did last year. The Dr. wrote for 2 boxes/month. After clarification with the Dr, we dispensed 2 boxes per month. We did this for around 8-9 months. Never once did we receive a rejection from prime, excessive dosage, qty, etc. They hit us up early last year, I provided them with a Physicians note on the MD's letterhead explaining that we dispensed the medication as intended. I argued for 8 months back and forth. In the end PRIME does not allow for any ambiguity with regards to directions.

Also, and you may want to keep this in mind for yourselves, all migraine meds dispensed need to have the amount of migraines the patient has per month documented on the original hard copy RX. This information can be put there by you, you just have to ask the patient how many migraines they have per month. Ridiculous.

 

[Old Timer]

Actually auditing is less intrusive than it used to be. Doctor M, you can call & re-schedule the audit if the timing is bad. Most comonaies will work with you. Also, ask for the beginning number and the ending number. You can run a report for that third party between those numbers and review the scripts in advance.

 

[Caverject]

I've never been audited but then again I don't have third party claims in my outpatient setting!

 

[Doctor M]

Actually auditing is less intrusive than it used to be. Doctor M, you can call & re-schedule the audit if the timing is bad. Most comonaies will work with you. Also, ask for the beginning number and the ending number. You can run a report for that third party between those numbers and review the scripts in advance.

Ha! I called the auditing company and they said NO, we cannot reschedule. They also are NOT giving me any information. They stated Prescription Solutions does not provide any info as to what will be audited. The auditor will show up and tell us what they want to see.

 

[Old Timer]

Ha! I called the auditing company and they said NO, we cannot reschedule. They also are NOT giving me any information. They stated Prescription Solutions does not provide any info as to what will be audited. The auditor will show up and tell us what they want to see.

That's amazing. They always give you the first & last numbers. You need to look at your contract. I have never been refused a change of date for an audit.

 

[Doctor M]

That's amazing. They always give you the first & last numbers. You need to look at your contract. I have never been refused a change of date for an audit.

I will do that when i get back from vacation oldtimer! I was amazed that they would not reschedule. Thanks for the info!

 

[lorain]

i can personally tell you its only gonna get worse

they are trying to make sure no cent goes wasted

when you have chemo therapies that cost 100 grand, they have to become efficient in other areas

 

[Its Z]

i can personally tell you its only gonna get worse

they are trying to make sure no cent goes wasted

when you have chemo therapies that cost 100 grand, they have to become efficient in other areas

Yup. I just rsceived an audit notice for our oncology service billing. Also preparing for HRSA 340b audit just in case. audit will be a part of our practice as a routine. so i decided to embrace it.

 

[007rx]

Its getting bad, we are writing a check to Prime for over $8K for some Migranol we did last year. The Dr. wrote for 2 boxes/month. After clarification with the Dr, we dispensed 2 boxes per month. We did this for around 8-9 months. Never once did we receive a rejection from prime, excessive dosage, qty, etc. They hit us up early last year, I provided them with a Physicians note on the MD's letterhead explaining that we dispensed the medication as intended. I argued for 8 months back and forth. In the end PRIME does not allow for any ambiguity with regards to directions.

Also, and you may want to keep this in mind for yourselves, all migraine meds dispensed need to have the amount of migraines the patient has per month documented on the original hard copy RX. This information can be put there by you, you just have to ask the patient how many migraines they have per month. Ridiculous.

Really?! So if a patient has one migraine per month, and lets say the script was for sumatriptan 100 mg tabs, you can only dispense two tabs/thirty days?

What if they just so happen to have a really stressful month and had a second migraine? Hopefully we could get an emergency override :-/

 

[Aznfarmerboi]

Ha! I called the auditing company and they said NO, we cannot reschedule. They also are NOT giving me any information. They stated Prescription Solutions does not provide any info as to what will be audited. The auditor will show up and tell us what they want to see.

Prescription solution is absolutely the worst PBM to deal with out there. I think it is out there to be as grimey as possible. They require PAs for everything (even ******ed stuff like zpacks), mail order without notifying the patient, and whenever you call them, they transfer you everywhere because no body there has a damn clue about their program.

 

[Farmercyst]

Really?! So if a patient has one migraine per month, and lets say the script was for sumatriptan 100 mg tabs, you can only dispense two tabs/thirty days?

What if they just so happen to have a really stressful month and had a second migraine? Hopefully we could get an emergency override :-/

Zomig 2.5 mg. 1 tab prn #QS 1 month supply. You don't think they'll audit that one right? I think they've gotten 30/month for the last 4 months. I saw it today and 🙄 Funny thing is, I don't know if we've ever questioned the doctor on it.

 

[007rx]

Zomig 2.5 mg. 1 tab prn #QS 1 month supply. You don't think they'll audit that one right? I think they've gotten 30/month for the last 4 months. I saw it today and 🙄 Funny thing is, I don't know if we've ever questioned the doctor on it.

Wow constant refills every month for at least four months? They need to have a talk about prophylaxis at this point I would imagine right? TCA or AED or CCB or beta-blocker...

 

[kvl1027]

Really?! So if a patient has one migraine per month, and lets say the script was for sumatriptan 100 mg tabs, you can only dispense two tabs/thirty days?

What if they just so happen to have a really stressful month and had a second migraine? Hopefully we could get an emergency override :-/

Well, the craziest thing about it is that you are not necessarily limited to only dispensing enough for that specific patient's needs. I think you can dispense beyond the pt's need, however if you exceed what the insurance company deems as being a reasonable qty/month then you better have the amount of migraines documented on the original RX.

It really is ridiculous and it is only going to get worse.