Pharmacy News: Medicare Audits Are On the Rise

clawbackIn recent Medicare Audits, over 80% of glucose testing supplies and nearly 70% of nebulizer and nebulizer solutions claims were denied.  This resulted in BILLIONS of dollars being recouped from Medicare Suppliers and providers.

As a Pharmacy Owner, are you prepared if an Auditor comes to your door?

When working with clients, I let them know there are several things that they can do in their pharmacy help prevent the clawback of  hard earned revenue.

  • Be sure you are in Compliance with all 30 Medicare Supplier Standards, whether you are Accredited or not.
  • Understand your DME-MAC’s LCDs (Local Coverage Determinations)
  • Have a Checklist available of all information that is required in a patient’s file.
  • Perform internal audits and quality assurance checks to ensure all of your patient files have the proper information included in them.
  • Have an open relationship with dispensing physicians so you can easily obtain needed information before sending your claims to Medicare.
  • Keep an eye on your mail, most audits will be a request for documentation sent to you by a Medicare Contractor and give typically 30 days to respond.  If you don’t reply, you will have lost your monies.
  • MOST IMPORTANTLY — Keep your staff trained and up to date on all requirements!

Make these practices part of your daily routine and you will be ready when that Medicare Auditor comes knocking.