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 68
Page 68 of 114 · 1029 articles
The Five Public Interest Factors in DEA Cases
DEA weighs five statutory factors in registration cases, but final orders turn on one threshold: an unequivocal acceptance of resp…
HCC Coding Accuracy and Risk Adjustment Enforcement
Unsupported HCC diagnosis codes inflate Medicare Advantage risk scores and can expose physician groups to RADV audits and False Cl…
Semaglutide Salt Forms: Why the Base Matters
FDA says semaglutide sodium and semaglutide acetate are different active ingredients than the approved base form, and enforcement…
Home Health Medicare Audits: Documentation Priorities
Homebound status, the face-to-face encounter, plan of care certification, and OASIS consistency drive the denials that recur in ho…
WellDyne Pharmacy Audit: Response Strategy
WellDyne runs pharmacy audits with less formalized appeal infrastructure than major PBMs, which changes the response and negotiati…
Vaccine Billing Audits at the Pharmacy Counter
Administration fee billing, PREP Act authority, and the consent, screening, and lot documentation PBM auditors check during vaccin…
Medicaid Timely Filing and Retroactive Eligibility Issues
The 12-month Medicaid timely filing deadline and the 3-month retroactive eligibility window can collide and read to auditors as fr…
Spread Pricing: What It Means for Independent Pharmacies
How PBM spread pricing works, what the FTC's report found, and the state Medicaid laws requiring pass-through pricing for pharmaci…
Specialty Drug Audit Defense for Pharmacies
Why specialty pharmacies face heavier PBM audit scrutiny, and the network, accreditation, and REMS documentation that defends agai…