Creating a Pharmacy Audit Checklist for Medicare Compliance

Implementing appropriate pharmacy policies and procedures is crucial to Medicare compliance. R.J. Hedges & Associates assists pharmacies in creating their own custom policies and keeping up-to-date on current requirements.

Use this digitized checklist to easily inspect 9 essential areas of your pharmacy. Free for smaller teams; premium accounts unlock unlimited reports and storage.

Prescriptions on Hand

Practitioners maintain a tightly managed inventory of medications and oversee who has access to them, as well as keeping an ongoing administration log that shows how many dosage units were dispensed each day – this helps identify whether any have been stolen or falsified, and also allows facilities to establish procedures to ensure any drug recalls are promptly reported and addressed.

The facility will establish a procedure to identify patients eligible to receive prescription refills through mail, as well as policies regarding storage, security, and replenishment of medication supplies.

Frier Levitt assists pharmacies in preparing for audits, responding to initial audit discrepancies, appealing final audit results and mitigating risks related to contract renegotiations or termination with PBMs. Our pharmacy compliance team can also offer guidance for complying with medical board regulations and state laws. Get in touch with us now so we can assist your audit preparation efforts.

Prescriptions Dispensed

Practitioners may prescribe unlabeled versions of marketed drugs as appropriate on an individual patient basis, though such medications cannot be stored and dispensed to multiple individuals in this way. Once used with one patient they must be relabeled according to outpatient prescription requirements before being returned back into stock for later use.

Controlled substances should be stored in a locked area with limited access for safety and security reasons, only accessible to pharmacists via secure will call systems (eg GSL Intellicab). CCTV cameras should also be installed within pharmacies and medication storage areas in order to document any unauthorised removal or diversion of medication.

Each facility will maintain a file of drug recall reports and action plans, while an outside senior level pharmacist will conduct an annual unannounced physical audit using the Pharmacy Controlled Substance Audit Tool to assess accuracy, identify discrepancies and monitor compliance with controlled substance procedures.

Prescriptions Mailed

Do you have a system in place for quickly packaging and sending delivery-related prescriptions out? Making this process more streamlined by clearly marking them for delivery with will-call bags or baskets will ensure their timely packaging. Consolidating multiple Rxs for one patient into one package also reduces processing time, as does checking that their names and addresses match those on shipping labels; to further ensure smooth deliveries your delivery drivers should ask patients to confirm these details prior to giving out packages to avoid confusion and delays in deliveries.

Frier Levitt assists pharmacies with audits by helping them prepare, respond and appeal the results of onsite and desktop audits, as well as mitigate risks related to contract renegotiations with PBMs. If your pharmacy requires assistance addressing an audit-related issue, contact us immediately so we can explore all available solutions.

Prescriptions Received

Pharmacies receive medications from various sources: voice calls from health professionals, faxes from hospitals or hand-in prescriptions. Each prescription is checked by one of the pharmacy team members to make sure that both doctor’s name is legible, dosage/dose information is correct and that coverage for that drug exists under an individual patient’s insurance plan.

Each facility will establish and implement a drug recall procedure to effectively track all recalls and notify patients who might be affected. A file will be kept to document this process and how and when notifications are sent out.

Prescriptions of controlled medications that are ready to be disbursed must be stored in an area accessible only by the pharmacist in order to reduce risks of diversion by staff members. Expired and non-controlled medicines will be disposed of according to facility policy; and a monthly inventory report will be created.