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Video instructions and help with filling out and completing Why Form 5495 Certification

Instructions and Help about Why Form 5495 Certification

Welcome to the pharmacy self-audit Inge control practices to improve Medicaid program integrity and quality. Module three invoice management presentation module 2 controlled substances management discussed how to incorporate an evaluation of controlled substances practices into a pharmacy self-audit. Steps 13 through 22 were reviewed and examined. Topics covered included hiring employees, how to handle internal diversion, controlled substances inventory management, handling loss or theft, and responsibilities of the pharmacist in charge. The P.I. sees the topics of prescription drug monitoring programs (PDMPs), lock-in programs, physical security, and communications were also covered. Invoice management is the third component of the self-audit process. Effective invoice management helps to detect and prevent fraud, waste, and abuse. Let's discuss the various approaches to validating wholesale invoices. To better understand how invoice management affects pharmacy practice, we will also discuss ways in which drug claims can exceed purchases. This includes when drugs are obtained from illegal sources, prescription drug samples are sold, drugs return to stock are resold, and drugs returned from institutions or patients are resold. Finally, the discussion addresses how drug claims can exceed sales through incentives, illegitimate prescriptions, point-of-sale billing manipulations, coordination of benefits manipulations, and phantom claims. Let's get started by reviewing the objectives for module 3. By the end of the module 3 invoice management presentation, you should be able to identify four pharmacy inventory management activities that may cause prescription claims to exceed drug purchases and recall five pharmacy billing activities that may cause prescription claims to exceed prescription sales. The audit process is a means of reviewing pharmacy practices to ensure staff members uphold operational procedures. State and federal programs such as Medicaid and Medicare Part D, state licensing boards, the U.S. Drug Enforcement Administration (DEA), the U.S. Internal Revenue Service (IRS), and other third-party payers conduct pharmacy audits. Through the pharmacy self-audit...