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IL license defense lawyerIn the healthcare industry, there are many safeguards put in place to protect patients. When it comes to medication and pharmacies, it is no different. PBM pharmacy audits are conducted both for the sake of the pharmacy benefit manager (PMB) and for you, the pharmacy owner. A PBM audit can be a stressful experience for a pharmacy, especially a small, independent one, but many pharmacies cannot operate at desired capacity without also working with a PBM. If you have an upcoming PBM pharmacy audit, proper preparation is key to success.

Documentation is Extremely Important

For many pharmacies, but especially independent pharmacies, documentation is often an area that needs attention. When your PBM auditor comes to your pharmacy, they may request to see certain documentation that could be from months or even years ago. This documentation could be anything to do with things such as supply changes, such as going from a 30-day supply to a 60-day supply, or early refills. Having your documentation completed, thorough, and organized will save you much stress during the audit.

Consistency Is Expected

Part of the job of a PBM auditor is to make sure that each patient receives the same standard of care when they use your pharmacy. This is accomplished by making sure that all employees are following the same rules and policies while they perform their job. When your PBM auditor is at your pharmacy, they will be looking for any errors made by your staff, such as checking the amount of medication dispensed or ensuring all of the proper forms and documentation are filled out. It is a good idea to have an official standard operating procedure (SOP) written out and distributed to all of your employees so that they understand what is expected of them every time they fill a prescription.

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b2ap3_thumbnail_DEA.jpgThe role of a pharmacy benefit manager (PBM) is one that is quite important in the health industry. PBM’s serve as the middleman between pharmacies and insurance companies and are necessary for a pharmacy to operate. Every once in a while, your PBM will contact you to inform you of an audit to ensure rules are being followed and business is being conducted as it should be. Being audited by anyone can be a nerve-wracking experience, especially if that audit is conducted by your PBM. A catastrophic PBM audit could leave lasting effects on your business. If you have been notified of an upcoming PBM audit, here are a few tips to help you prepare for your audit:‘

  • Ensure you are there for the audit. When you receive notice of the audit, the exact date and time will also be mentioned. Make sure you are in the pharmacy at that time and that you are free to work with the auditor while they are there.
  • Review the audit rules. Once you have received notification of the audit, you should review the audit section of the PBM’s manual. This section will contain information about the auditor’s procedures that you should be familiar with.
  • Begin to organize your documents. In the audit notice, there should be a date range that the auditor will be focusing on. In some cases, actual prescription numbers will be provided. Be sure to have all records pertaining to the prescriptions filled within those dates and keep them in one place.
  • Conduct a staff meeting. Not only should you be prepared for the audit, but your staff should also be prepared. Hold a meeting to inform your staff members of the date and time of the audit and of your expectations of them during the audit.

Concerned About an Upcoming Audit? Contact a Knowledgeable Illinois PBM Audit Lawyer

When it comes to any audit, especially a PBM audit, preparation is key for a successful outcome. If you have gotten notice of an upcoming PBM audit, you should contact a skilled Illinois PBM audit attorney. The Law Offices of Joseph J. Bogdan, LLC has been helping clients prepare for PBM audits and advising clients of their next steps after PBM audits for more than 16 years. Being both an attorney and a registered pharmacist, Attorney Joseph Bogdan has the legal and medical knowledge needed to help you make the best decisions for your pharmacy. Call our office today at 630-310-1267 to schedule a consultation.

 

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IL license defense lawyerAudits to your pharmacy can be made by insurance companies, pharmacy benefit managers and third-party payers. Many pharmacy owners view audits as a threat to their business and with good reason.

The outcome of an audit can mean that a pharmacy is required to pay large sums of money that the auditing agency says it is owed. This could be taken out of what would be payments from future money that would be paid to the pharmacy.

Audits should be taken seriously, and often an attorney can safeguard a pharmacy’s rights as well as negotiate issues that may come up in the course of an audit.

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IL licensing attorneyIf you have received notice of an upcoming pharmacy benefit managers (PBM) audit, there are several things you can do to prepare. The consequences of a PBM audit are real and can be long-lasting. Going into an audit prepared is advisable.

Many clients find that adequate preparation can alleviate problems that can come up during an audit. A skilled PBM audit defense attorney can identify specific areas that you should focus on in the time before your pharmacy’s audit. However, typically you will benefit from taking the following steps:

  • Review the written on-site audit notification. You want to pay close attention to the scope of the audit, including the date ranges that the audit will cover. The terms of the audit as stated in the letter should comply with your contract and will applicable laws. An attorney may be needed to determine compliance.
  • Check the date of the proposed audit. This date should be a date when you and other needed personnel will be present. An audit should not be left to employees to handle.
  • Create an audit file. This file or box should contain all correspondence, records, notes, and documentation of telephone calls related to the audit.
  • Meet with your staff. Your staff should be prepared for the audit as well.
  • Organize your records and conduct a self-audit. You should review what records you have as well as identify any problem areas that the PBM auditor may spot.
  • Prepare a designated physical area for the audit. This area should be private. It should also be away from your employees’ spaces and pharmacy operations. Often a closed-off breakroom with a table and chair is suitable.

Contact an Illinois PBM Audit Attorney

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