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 72
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Separate Registration for Each Location
DEA registration attaches to the address, not the owner. What the separate-registration rule requires when a pharmacy moves or exp…
Recoupment Offsets Against Future Claims: Your Options
When a PBM offsets a recoupment against future claims, the cash-flow hit starts immediately. What the withhold mechanic does, and…
Duplicate Billing Findings in Medicaid Audits
Duplicate claims are among the most common Medicaid audit findings. Whether one resolves as a refund or a fraud referral turns on…
Chiropractic Medicare Audits: The AT Modifier Problem
Medicare requires the AT modifier to prove active chiropractic treatment, not maintenance care. What the documentation has to show…
EPSDT Claims and Medicaid Audit Exposure
EPSDT is defined by five mandatory components, not one visit code. Incomplete documentation of any one of them is what state Medic…
Practitioner DEA Registration Denials and Appeals
A DEA registration denial reaches every corner of a practice. What the public interest factors require, the hearing right, and how…
Behavioral Health Medicare Audits
Medicare audits of behavioral health claims turn on session time and format documentation. What CMS and MAC guidance actually requ…
Reading Your PBM Provider Manual Before the Audit
PBM provider manuals are incorporated into the network agreement and often decide audit disputes. What pharmacies should read befo…
Preparing for a DEA Inspection Before It Happens
A self-audit of controlled substance records, staff preparation, and corrected deficiencies shape how a DEA inspection goes before…