Audits, Billing, Compliance – The ABCs of PBM Billing

PBM Audit. No two words are more guaranteed to raise your blood pressure immediately upon hearing. Why? Because whatever made up rules the PBM has imposed, the claims you have submitted have already happened and money is coming out of your pocket. Some audits can even result in your contract being at stake.

Abiding by state and federal pharmacy laws is part of being a pharmacist and pharmacy owner. Jumping through the myriad hoops of PBM “rules” is a whole different matter. CVS’s latest manual is 345 pages long while Express Scripts is 121 pages and OptumRx’s is 160 pages.

One of the most frustrating aspects of owning a pharmacy is the threat of PBM audits. Retrospective recoupments of claims, where the medication has been bought and paid for by you, is not only financially painful but incredibly frustrating. What are the do’s and don’ts of PBM billing?

PDS is pleased to announce the first PBM billing class teaching the ins and outs of your PBM manuals and contracts. Join us for the inaugural class for a deep dive of CVS, ESI, OptumRx and Prime Therapeutics contractual and manual language. Taught by the Pharmacy Compliance Consulting team of Chris Gruber and Mark Newkirk, learn the manual language and traps in order to protect your business and livelihood.

Next Audit, Billing, Compliance Training Sessions

Spring 2019
Atlanta, GA
March 29-30, 2019

Summer 2019
Denver, CO
August 2-3, 2019

Who Should Attend
Audit, Billing, Compliance Training? 

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    Pharmacy Owners
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    Pharmacy Managers
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    Key Billing Employees

ABCs of PBM Billing is available
exclusively to PDS members.

Pricing For Audit, Billing, Compliance

  • $750 Elite & Premier Members
  • $1,500 List Price

Ignorance is not bliss when it comes to PBMs 

Billing a claim to an insurance is pretty easy work. With a few pushes of some buttons you can send a claim and get a response in a matter of seconds. If that is your staff's understanding of the billing process you and your pharmacy are at risk. Billing is so much more complicated than inputting the information onto a screen. Educate yourself and your staff on the rules in each contract that way audit won't be a 4-letter word in your pharmacy. 

Attendees will learn: 

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    The do's and don'ts of your most important PBM contracts so you can confidently bill prescriptions 
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    How to avoid the common traps that await you in PBM contracts. 
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    Your rights during an audit and how to properly handle an audit when you receive one.  

Top Benefits

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    Learn information to help with audits, current or in the future.  
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    Each contract is unique and the differences are important to understand. 
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    Give your employees the confidence they need to thrive in their roles. 
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    No longer feel powerless when dealing with PBMs.

Financial Impact

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    Keep more of your high-profit earnings by remaining in compliance with your contracts.  
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    Confidently bill high margin prescriptions, knowing you are in compliance. 
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    Keep your contracts by avoiding risky billing behaviors.  

Not A Member? 

Our comprehensive suite of courses will address all your training and team development needs from leadership to technician training. PDS also has developed a full offering of pharmacy specific niche program trainings that are sure to benefit your patients and to increase your profits.