In 2011, PAAS members experienced more than one audit per pharmacy. With more government emphasis on preventing fraud, waste and abuse; the number of audits will increase in 2012. Most pharmacies will experience multiple audits in 2012.
The timely and proactive tips you receive from PAAS will definitely help you save money. And if you are audited, you will find PAAS assistance to be a lifesaver. In 2008 the average audit charge-back was $6,721. There was a 11% chance of receiving an audit with over a $20,000 charge-back demand. By working with PAAS, on average members were able to reduce their audit payback by $5,504 to only $1,217 or just 22% of the original demand. The savings in just one audit produces a 15-time return on investment.
A Random Audit—not likely! A PBM or Managed Care Plan picks your pharmacy for a reason. They create complex electronic algorithms to select pharmacies and prescription claims most likely to have discrepancies and then push them into their subterranean audit networks—all from your real-time data. They constantly scan claims for any hiccup. If you fall outside of the norm, BANG!! The Third Party's warning flag pops up and your pharmacy is scheduled for an audit.
How are you viewed under their microscope?
PBMs and Managed Care Plans scrutinize a multitude of dispensing behaviors including day supply, brand overutilization, DAW patterns, claims volume, claims reversal rates, cost per claim, incidence of specific drugs, refill patterns and many, many more.
Edward Heckman and his Audit Analyst Team have extensive experience in hundreds of different audits. We have worked with audits from the big three PBMs – Medco, CVS Caremark and Express Scripts; down to the smallest Managed Care Plans and many different audit types including Compounding Audits.
Your membership entitles you to the following benefits:
PAAS Member Manual The PAAS Member Manual will help you safely bill prescriptions in your day-to-day operation of your pharmacy.
Contract Reviews PAAS National® will review and analyze national contracts for you and identify potential risks and the financial implications.
Audit Assistance From the first notification of an Audit to the finalization of your audit results, we are only a phone call away.
Third-Party Newsline PAAS mails to all members a member-favorite monthly newsletter. The Third-Party Newsline keeps you current on all the happenings in the Pharmacy world. Members keep it handy for frequent references.
PAAS Forms PAAS provides an array of important forms for members. Signature Log Books, Signature Log PostCards, Patient Affidavits, Compounding Protocols, HIPAA Use & Disclosure Information, Sample Press Release and Patient Letters are only a few of the extras that are available to you.