pharmacy audit and invoice

[ZakMeister]

How often have you guys seen Medicaid/Medicare or even commericial insurances ask for invoices as part of rx audits? In my very short experience so far I have gone through one Humana audit where they just basically looked at the validity and accuracy of rx's.

But then when we try to EXACTLY bill the ndc of the drug we actually dispense it makes me wonder if in audit some of those rare mismatches will be penalized..

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[owlegrad]

Good question. I used to wonder this when FL Medicaid required stupid brand Adderall. Would they ever *really* know?

Then I remembered that I am a professional, not @Sparda29 😉

 

[zelman]

I think this is done when a pharmacy is billing for expensive items and it's abnormal for their area. Pharmacies have been known to bill for things like expensive nutritional foods every month for patients with a $0 copay while never ordering the product.

 

[imcallingcorp]

How often have you guys seen Medicaid/Medicare or even commericial insurances ask for invoices as part of rx audits? In my very short experience so far I have gone through one Humana audit where they just basically looked at the validity and accuracy of rx's.

But then when we try to EXACTLY bill the ndc of the drug we actually dispense it makes me wonder if in audit some of those rare mismatches will be penalized..

I’m gonna assume this is an independant pharmacy in which case this is a very common audit. They will look at your most billed most expensive rxs and look for discrepencies against your invoices. So if you billed 10 rxs of drug A you better have ordered that many as well.

 

[ZakMeister]

I’m gonna assume this is an independant pharmacy in which case this is a very common audit. They will look at your most billed most expensive rxs and look for discrepencies against your invoices. So if you billed 10 rxs of drug A you better have ordered that many as well.

it is indeed a small chain independent. At one of their stores, the manager doesn't care which NDC is being used and what we bill for..like we don't care about the HTN pills, cheap topicals etc.

 

[maria1oh]

It's difficult sometimes to bill the correct NDC for OTC items. Test strips billing for 100 ct box but dispensing two 50 count boxes.

 

[Claydoe]

It's common, here's what happens when your invoices don't match what you're billing. Lakewood pharmacy agrees to repay $878,083 to Medicaid, state comptroller says

 

[Sparda29]

Yep, invoices gotta match the billing.

 

[imcallingcorp]

it is indeed a small chain independent. At one of their stores, the manager doesn't care which NDC is being used and what we bill for..like we don't care about the HTN pills, cheap topicals etc.

they are looking for fraud. they could care less about which ndc amlodipine you bill or order. they’re lookin at your inhalers, insulins, hiv, etc drugs. they aren’t checking that the ndc is right they’re checking that its billed, ordered, and picked up by patient. for some reason its 2017 and there are pharmacies only engaging in the billing part. these folks are dumb like i said its 2017 a 5 min inventory audit and its a wrap.

 

[SClENCE]

They don't care with NDC of lisinopril you handed out. They just want to make sure that the $100,000 worth of insulin that you billed for was actually in the pharmacy at some point.