Are you sending this message to PBMs/health plans?
The AuditGuardian newsletter, published by the United
Drugs AuditGuard team, recently published a list of the
“Top 10 Audit Discrepancies” based on audits at United
Drugs member pharmacies:
1. Overbilled Quantity
2. Use as directed
3. Incorrect drug, patient, or directions
4. Missing Prescription
5. Missing Signature Log
6. Invoice purchase shorts
7. Wrong prescriber submitted on claim
8. Refill too soon – not documented
9. Inappropriate use of DAW code
10. Override or change order not documented
*Data based on actual audit chargebacks from preliminary audit determinations.
Let’s Talk DAW Codes
United Drugs recently reviewed three months of prescription
claim data for an individual single source brand drug to
evaluate the quantity and days supply dispensing patterns.
Noted in the claim review were 588 claims that an auditor
can/will cite as “Inappropriate Use of a DAW Code”.
The total potential chargeback amount of these incorrect
DAW claims is…. $140,633 all of which are preventable
dispensing errors and result in a profit loss for pharmacies.
Results of our claim data reviewed are listed in the chart below:
The appropriate DAW code on a single-source brand (a
brand with no available generic) is always zero. There is no
exception in any pharmacy provider manual of any PBM or
The AuditGuard program has dedicated audit consultants
available to work with our member pharmacies to provide
in-depth tracking of their audit activities. While assistance at
each step of the audit process is vital, our goal is to provide
the educational tools that will prevent audit discrepancies and
ultimately, audit chargebacks.
Since its launch in July 2010, the AuditGuard program has
saved member pharmacies over half a million dollars.
The goal of the AuditGuard program is to
protect your bottom line because there is a
100% chance you will be audited, but there
doesn’t have to be a 100% guarantee that you
will owe money to a PBM and/or health plan.
AuditGuard has just released two new helpful guides for our
managed care member pharmacies – the first was developed
to assist with navigating the Fraud, Waste, and Abuse
requirements of CMS and the second to provide information
on proper Quantity & Days Supply Dispensing. Both guides
along with AudiTips, and AuditGuardian newsletter are a
service of the AuditGuard program.
To request your copy of one or both guides please e-mail:
email@example.com or firstname.lastname@example.org.