Preventing Third-Party Pharmacy Audits and Clawbacks
It is probably fair to say that at the moment people hear they are going to be audited they feel a certain amount of anxiety. The key to meeting challenges associated with audits lies in completely understanding the process and being ready for any circumstances that arise. The three modules in this continuing education lesson will help you to achieve these two objectives.
The first module will provide you with background that lays the foundation for understanding of the third-party payer environment and challenges associated with third-party prescription billing.
The second module will help you to understand the steps involved in a third-party pharmacy audit, the particular practices that trigger the audit itself, as well as clawbacks.
The third module is entitled "The Audit Survival Plan” and will use a case study approach to take you through the steps of an actual audit so that you will know what to expect and will be able to deal with the circumstances effectively.
This program has been supported by an unrestricted grant from Mylan. For more information on Mylan, please visit www.mylan.ca.
Please see the appendix within for examples of third-party ajudicator policies and claim manuals.