Manage audits and mitigate risk

The recent evolution of healthcare has resulted in a historically high volume of prescriptions, with a growing portion funded by government payers. With this growth comes increased audit activity and regulatory oversight for fraud, waste and abuse.

Increase in Audits Across the Industry

Dispensed Prescriptions Mn – by Payment Type

2009 2010 2011 2012 2013
Total U.S. Market 3,953 3,995 4,022 4,139 4,208
Commercial Third-Party 62.9% 61.6% 61.3% 58.6% 57%
Medicare Part D 19.9% 19.8% 20.6% 23.7% 26.0%
Medicaid 8.3% 9.6% 9.5% 9.4% 9.0%
Cash 8.9% 9.0% 8.6% 8.3% 8.0%

Source: IMS Health, National Prescription Audit, XPonent, PlanTrak Jan 2014

What are you experiencing?

  • How many audits do you receive? What is the average value?
  • How successful are you negotiating recoupments down?
  • Have you identified any triggers for audits?
  • How do you validate takebacks were what you agreed to?
  • How much time do you spend managing each audit?
  • How successful are you at re-billing to prevent audits or adding more dispensing controls?
  • How do you keep audit records? Do you ever have challenges?

The answers to these questions are now more important than ever. Pharmacies need the right tools to manage audits, which can that range from a few claims up to tens of thousands of dollars, as well as the risk of audit recoupments.

Inmar’s Rx Audit Management web app enables pharmacies to manage audits from pharmacy payers through a workflow process designed to quantify audits, identify impacted claims, and negotiate and manage take-backs.

Reports and dashboards offer quantitative results as well as insight into industry benchmarks and trends. Complete audit volume and frequency visibility allows tracking and forecasting of audit activity, and carriers’ compliance with contracted audit language.

Audit intelligence makes it easy for clients to identify which claims are targeted the most and implement controls in the dispensing process to help prevent future audits.

Inmar’s easy to use Audit Management Web App

  • Increases audit recovery rates with robust data to better negotiate recoupments.
    • 98 to 99% recovery rates
  • Reduces initial audit exposure and helps prevent future audits with business intelligence.
  • Improves audit workflow and manages audits from receipt through final recoupment.
  • Enables faster turnaround times to meet audit requirements.
  • Provides better validation of agreed upon take-backs with visibility into audit adjustment activity on remittance.
  • Improves record keeping and reporting to provide audit security.
  • Improves store compliance with reducing actions that trigger audits.

Clients are reporting 200-400% increase in audits.

Ready to get started?

Ready to learn more about Rx Audit Management or another Inmar product or service? Contact us using one of the methods below and we’ll be happy to help.

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