Insights & Analysis
Practical guidance on PBM audits, federal investigations, compounding defense, DEA enforcement, telehealth compliance, and the regulatory pressures facing pharmacies and providers nationwide.
More articles — Page 35
Page 35 of 113 · 1018 articles
UPIC Audits When a Third-Party Billing Company Prepared the Claims
The provider stays the party of record when a UPIC audits claims a third-party biller prepared. What to gather, what contract term…
Responding to a Draft Medicaid Audit Report
A draft Medicaid audit report sets the record the rest of the case works from. Letting the response window pass turns findings int…
Vetting a 503B Outsourcing Facility Before You Order
A hospital, clinic, or practice that orders from a 503B outsourcing facility inherits its compliance record. A buyer-side checklis…
The RAC Discussion Period: Raising Issues Before the Demand Letter
The 30-day RAC discussion period runs on the review results letter, not the demand letter, and it does not pause the separate 120-…
Treasury Referral of an Unpaid Medicare Overpayment
What happens once a Medicare overpayment demand goes unpaid: referral to Treasury for cross-servicing and offset, and what closes…
Medicaid Revalidation and Provider Number Deactivation
State Medicaid revalidation cycles trigger risk-based screening and site visits, and a missed window deactivates the provider numb…
Responding to a DEA Letter of Admonition
A DEA Letter of Admonition sits between an inspection finding and a formal order to show cause, and the response becomes part of t…
The 503B Bulk Drug Substances List and the Clinical Need Standard
The 503B Bulks List governs outsourcing facilities under its own clinical need standard, separate from the 503A list, with a short…
Medicaid Recovery Audit Contractors and What They Review
A Medicaid RAC's contingency-fee review runs on a different track than a state program integrity audit or a managed care plan's SI…