A popular blog written by an Iowa pharmacy owner recently detailed the author’s experiences with audits of his business. “Over my career as a pharmacy owner, we have faced over $1 million worth of audited claims, and the PBMs [pharmacy benefit managers] have attempted to charge back over 10% of that amount,” the blogger wrote. “A single audit may include over 100 individual prescriptions representing as many as 250 dispense dates and may represent over $100,000 in sales.”
This particular pharmacist went on to note his near-100% success rate in defending his pharmacies from unfair chargebacks — a process that required a considerable investment of time and energy.
Similar examples were reported by Health Mart, which cited one Pennsylvania pharmacy owner whose three stores were audited “about 30 times” in a single year. Another owner of five pharmacies in Ohio said his staff typically handles three to five audits at any given time.
Pharmacy audits can come at any time, and in many forms, ranging from a less-intrusive telephone audit to a highly invasive field audit, which can consume dozens of hours in preparation, plus days spent meeting with auditors and addressing points of inquiry. Hanging over all audits, of course, is the threat of financial repercussions, including clawbacks of fees determined to have been paid in error, penalties, and even contract cancellations.
While no two audits are ever exactly the same, most have a few key elements in common, namely the need to provide seamless documentation trails for all critical pharmacy transactions, including prescribing and billing practices, invoice maintenance and controlled-substance management.
The good news for pharmacy managers though, is that whereas locating required documentation and records used to mean hours spent hunting through file boxes, today that information can be just a few clicks away. A pharmacy’s technology solution — including Micro Merchant Systems’ PrimeRx operating system, which already serves as the pharmacy workhorse by facilitating workflow and prescription-filling processes — can also be a one-stop solution for the most-requested audit documents.
A comprehensive technology system such as PrimeRx will allow for the capture, archiving, and storage of critical capabilities, including:
- Electronic signature logs.
- Proof of prescription pickups and deliveries.
- Copies of all prescriptions, both front and back.
- Payment documentation.
- Coordination of benefits.
- Prescription inventory records.
- Copies of all pharmacy correspondence, including exchanges between the pharmacy and the patient.
- Automatic inventory management and reordering procedures.
- Automatic inventory adjustments to reflect medications returned to stock.
- Verification of prescriber credentials.
- Assignment of NDC codes.
- Proper billing practices for generic and brand-name drugs.
- Documentation for controlled-substance handling.
- Automatic warning triggers for potential overprescribing of opioids and other controlled drug categories.
- Automatic triggers to reduce dispensing errors; and
- Seamless insurance claims management.
Easy access to any of these data elements can be a tremendous timesaver in preparing for an audit, and allow pharmacy managers to address auditor documentation requests.
Micro Merchant Systems has released a new white paper, “Manage Pharmacy Audit Risk with Technology and Internal Controls,” which provides a more in-depth discussion about today’s audit procedures and opportunities to better prepare for the inevitable audit notification.
With the right technology solution in place, pharmacy audits no longer have to mean panic and worry. CT