Are you concerned about managed care audits?

If you’ve ever been subjected to an audit from a third-party payer, PBM (pharmacy benefit manager), or managed care organization, you know it can be at best a major time consumer, and at worst a very expensive process both in time and in money. I have heard, and personally experienced, audits in which small errors get multiplied and turned into demands from the auditors for payback of major alleged overpayments.

I understand audits must be done. In fact, I created and ran an auditing company that audited wholesalers on behalf of manufacturers. These audits can be “gotcha exercises,” or they can be a cross-pollination of best practices. We preferred the latter, and I believe that approach had an impact on improvements over the last few years in the pharmaceutical supply chain.

The Academy of Managed Care Pharmacy (AMCP) is conducting an important survey of pharmacists as part of their efforts to develop model guidelines for pharmacy claims audits. They would like as many community pharmacists as possible to participate. I’ve cut and pasted their information below. I encourage you to participate via this link.

Dear Colleague,

Through its Community Pharmacy Outreach Advisory Council, the Academy of Managed Care Pharmacy (AMCP) is in the process of developing model guidelines for pharmacy claims audits. The Council is composed of pharmacists from both community pharmacy practice and managed care pharmacy.

We are currently in the research phase of development and we are reaching out to those in community pharmacy practice to learn more about the following:

• Types of pharmacy claims audits you have experienced
• The pharmacy claims audit process
• What works well within the pharmacy claims audit process and what does not
• What challenges community pharmacy practice faces with the current pharmacy claims audit process
• And, any other challenges you have faced related to pharmacy claims auditing

We would like to better understand the issues you have so that they are addressed during the model guidelines development process and have developed a quick survey that takes a pulse of your experience with pharmacy claims audits.

The survey results will be aggregated and used only by the Council and staff working on this project. Results will not be published. Your individual responses are not identifiable and will be confidential.

Use this link to access the survey: http://fs6.formsite.com/AMCP/RxAuditCommPharm/index.html

Please submit your results no later than 11:59 pm (Eastern) on November 15, 2010.

Thank you for taking time to complete this survey. It should take no longer than 10 minutes.

Cordially,
AMCP Community Pharmacy Outreach Advisory Council

P.S. If you have questions about the survey, please contact AMCP’s April Shaughnessy at ashaughnessy@amcp.org.