Pharmacy Benefit Managers (PBMs) play a vital role in the
healthcare industry, facilitating the administration and management of
prescription drug benefits. As part of their oversight responsibilities, PBMs
conduct audits to ensure compliance, accuracy, and transparency within the
pharmacy network. Not only does QRx provide audit tips but also provides our clients with a comprehensive Audit
Toolkit resource document that provides detailed best practices and specific
tips for reducing audit exposure.
Navigating PBM Audits Effectively:
To navigate PBM audits successfully, pharmacies can consider
the following best practices:
a. Maintain Accurate Documentation: Robust documentation of
prescription claims, patient records, inventory management, and compliance measures
is essential to demonstrate adherence to PBM requirements.
b. Regular Internal Audits: Conducting periodic internal
audits can help pharmacies proactively identify and rectify potential issues
before a PBM audit. It also allows for continuous improvement in operational
processes.
c. Stay Informed: Stay up to date with PBM policies,
contractual obligations, and regulatory changes to ensure compliance and
proactively address any emerging concerns.
d. Engage in Open Communication: Establish a proactive relationship
with the PBM, engaging in open and transparent communication. Seek
clarification on audit expectations, address any concerns, and learn from the
feedback provided.
Not only does QRx provide audit tips but also provides our clients with a comprehensive Audit
Toolkit resource document that provides detailed best practices and specific
tips for reducing audit exposure.
Understanding PBM audits is crucial for pharmacies to maintain compliance, optimize operational efficiency, and ensure quality patient care. By comprehending the types, purposes, and benefits of PBM audits, pharmacies can proactively prepare, navigate the process effectively, and embrace opportunities for improvement. QRx provides a comprehensive review of the pharmacy claims allowing to lower the number of audit triggers at PBMs. QRx reviews every Third-party claim to ensure accuracy, compliance, and additional reimbursement when appropriate. We provide superior customer service with seamless implementation of edits and reporting. We are also able to provide customized edits and reports as needed for the never-ending changes in the pharmacy industry. Let us help you navigate the audit challenges for your pharmacy. For more information contact Angie Smith at 678-400-0738 or scan the code below.
