Receiving notification that your pharmacy will undergo an insurance company audit can make for stressful times. This is true even if you believe you have been fully compliant.
One way to look at the situation is this: You want to run the best pharmacy possible, and audits can help you do that. Here are some tips to prepare.
Ensure adequate staffing
You should know the date the audit will take place. Have a few extra staffers working that day since you or your pharmacy assistant will be busy with audit matters. Always take audits seriously because auditors could be looking at events going back two years or close to two years. One mistake could turn into a huge deal that costs many thousands of dollars. Have complete documentation available.
Choose the pharmacy assistant wisely
Few things are worse than knowing that your pharmacy is compliant but finding out that the pharmacy assistant who helped with the audit did not how to properly answer some questions or how to show some documentation. The first thing is to choose the pharmacy assistant carefully. Look for someone with an attention to detail–and someone who is also friendly and personable. This person should also have a lot of experience working in the pharmacy.
Things the assistants should know and have ready include:
- Policies on compounding and delivering medication
- The process for sending and storing billing records
- Logs of signatures, whether manual or electronic
While preparing, put your highest efforts toward the medications that cost most. That is, brand names, inhalers and the like. Keep in mind that if the auditors do find problems, you can appeal and get an attorney to help if need be.
Of course, your pharmacy may undergo other types of audits, not just those by an insurance company. If legal complications could potentially occur (or have occurred), it is a good idea to get in touch with an attorney.