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
March 29-30, 2019
August 2-3, 2019
Who Should Attend
Audit, Billing, Compliance Training?
ABCs of PBM Billing is available
exclusively to PDS members.
Pricing For Audit, Billing, Compliance
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:
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.