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Academy of Managed Care Pharmacy (AMCP) Releases Model Audit Guidelines for Pharmacy Claims
Date:1/13/2012

ALEXANDRIA, Va., Jan. 13, 2012 /PRNewswire-USNewswire/ -- The Academy of Managed Care Pharmacy (AMCP) is pleased to announce the release of Model Audit Guidelines for Pharmacy Claims – a resource that fulfills a significant need in the pharmacy arena and addresses a challenge between the community and managed care pharmacy practice.

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The 21-page Model Guidelines document was developed collaboratively by a diverse group of pharmacy stakeholders. It is designed to help managed care organizations (MCOs) develop an effective pharmacy claims audit program, while helping pharmacists to better understand audit requirements and processes.

"We are proud to have played a key role in bringing forth this resource that will help various parties involved in the pharmacy claims process," said AMCP CEO Edith A. Rosato R.Ph., IOM.

"Audits of pharmacy claims are a necessary function in today's health care system," Rosato added. "But they too often are clouded by misunderstandings regarding their intent and how they are carried out. These Guidelines provide very practical recommendations for managed care organizations and community pharmacies to ensure a smooth process for everyone."

The auditing of pharmacy claims serves two main purposes: 1) detecting fraud, waste and abuse, and 2) validating data entry and documentation to ensure they meet regulatory and contractual requirements. Audits remain the primary method presently available for MCOs to determine network pharmacy compliance and to identify fraud, waste and abuse within the prescription drug benefit, as these contribute to the rising cost of health care.

The audit process has become essential under the Medicare Part D program, as the federal government increases its scrutiny of pharmacy claims and billing practices.
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SOURCE Academy of Managed Care Pharmacy
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