Keeping up with ever-changing health regulations is a demanding task you have to balance with the daily operations of your pharmacy. Whether you follow everything to a T or unintentionally miss something, you face the likelihood of an audit.
In most cases, you will receive notification of the inspection, but sometimes it can be unexpected. Either way, you need to know what to expect and how you can prepare to make the process go smoothly.
Type of audit
First, be aware of the type of audit so you know what to prepare. An in-person visit entails the representative observing the facility, reviewing claims from the past 12 to 24 months and ensuring compliance with regulations. For small issues, a rep may contact you via phone or mail and ask for records. Some audits utilize automation to verify data.
Before the audit occurs, have all the necessary documentation ready. Ensure your records are current and organized and that you have a thorough policies and procedures handbook that all employees are familiar with. For an on-site audit, make sure you have enough people working while you and/or a technician participate in the review process with the rep.
For unannounced audits, verify the rep’s identity. Whether or not you knew the person was coming, stay with him or her the whole time.
The auditor will likely look over the following areas:
- Licensing and training of all staff
- Privacy and security of patient information
- Procedures for misfills, recalls and expired medications
- Inventory and signature logs
- Part D prescriptions (Medicare fraud is a huge issue)
Expect lots of questions, as well as a discussion at the end.
Soon after the visit, the auditor will send you the results of the audit. They are not set in stone, however. Audit abuse and errors happen. You have the right to appeal insurance adjustments and submit further evidence supporting your claims.