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Fraud, Waste and Abuse Compliance
For some reason, it seems people think fraud, waste and abuse prevention compliance is difficult. While it is boring and it clearly has some scary ramifications when not followed, it’s actually very simple and fairly easy to implement. In this article, we will discuss why having a FWA prevention compliance program is important, things you can do to get started, examples of other people who thought they didn’t need to have all their FWA items in place and the issues they got into and some solutions to keep you from getting into hot water with Medicare and OIG.
Prior to the 1940s, nearly all prescription medications were compounded. With the increased demand for mass manufacturing of drugs after World War II, the number of compounded medications quickly dwindled. Unfortunately, this led many patients to not have all their needs met. Luckily today, many community pharmacies are able to compound medications to help personalize medications for patients who need alternate strengths, dosage forms, flavors and even alter ingredients because of allergies or sensitivities.
In order to stay competitive, many businesses are turning to offshore companies as a way to cut costs while still providing tech support, customer service, billing processes, and more. Consider your contracted companies with which you have signed a business associate agreement (BAA); could any of them be utilizing offshore workforces?
Applying for a Medicare number, commonly known as a PTAN (Provider Transaction Access Number), can be incredibly beneficial and difficult for Independent Pharmacies. This application can lead to more profits and allow for better patient care for senior patients but can also drive pharmacists crazy; the enrollment process can be lengthy, it can be challenging to determine which application to submit and confusing which sections to complete.
A Medicare number or a PTAN (Provider Transaction Access Number) is essential for independent pharmacies, but the enrollment process can take months and many pharmacists have trouble navigating the complicated forms.
Can every pharmacist give immunizations? What are the restrictions and license requirements? How do you bill for immunizations? Who can administer vaccines in the pharmacy? How can I improve my pharmacy business by doing immunizations? Why should I do travel vaccines?
Jeff Hedges, our in-house compliance expert and CEO of R.J. Hedges and Associates, answers all these questions and more in the latest Pharmacy Compliance Podcast: Pharmacy Immunzitions - It's More Than Just Flu Shots.
Medicare Application by the Numbers: Pharmacy Compliance Guide Summary
Applying for a Medicare number, also known as PTAN, can be time-consuming, confusing and quite daunting as there are almost 50 pages in the CMS 855B alone! First, you need to determine which application needs completed based on the services you hope to offer. Then the next challenge is to determine which sections need completed. Are there additional forms to complete, what extra documents need included, how and where to submit payment? Then the longest part, waiting to see if you have been approved or denied!