More Compliance audits are being conducted by PBMs and Third Party Payors. Compliance audits are designed to ensure that a pharmacy is compliant with network contractual requirements, state and federal regulations, and plan/program design while on-site audits generally involve physical observations, prescription reviews, inventory, and checks for compliance with Part D regulations and procedures.
What is not anticipated by most pharmacies is how the results of these audits could impact their business. Most network agreements have language to enable termination from networks when a pharmacy fails to comply with terms of the contract and compliance audits identify any deficiencies making a pharmacy vulnerable.
During a Mock Audit™, a CAPS team member will come into your pharmacy and simulate an audit as closely as possible. It will include a review of your prescriptions, records and procedures as if your pharmacy were undergoing an actual compliance and third party audit.
Mock Audit™ is a new, innovative method of preparing a pharmacy for the rigorous steps required by an audit and it’s available exclusively from Comprehensive Audit Prevention Services. Whether you are a new pharmacy owner, or planning on buying or selling a pharmacy, or are an experienced pharmacy, a Mock Audit™ by CAPS will increase your confidence and peace of mind in your business and claims practices.
During a Mock Audit™, a CAPS team member will come into your pharmacy and simulate an audit as closely as possible. It will include a review of your prescriptions, records and procedures as if your pharmacy were undergoing an actual compliance and third party audit. Pharmacy owners are provided with a comprehensive report of the Mock Audit™ findings, and most importantly, CAPS team members work with a pharmacy directly to correct any deficiencies which are identified in the audit report.
When CAPS began to offer this service it was primarily to help pharmacies determine if they are compliant with regulations and identify if there is any risk or exposure by a claims review. Since its launch, we are anticipating added benefits to potential pharmacy buyers and sellers. By engaging in this service, a potential buyer would know where the pharmacy stands on its compliance and be able to readily adapt business practices to the newly acquired pharmacy. This could drastically reduce the amount of man-hours spent identifying those areas where new policies and procedures should be drafted or changes made to existing ones so the new owner can focus on growing the business instead of worrying about where the risk is. Additionally, CAPS will provide a membership to any “selling” pharmacy that uses this service and transfer the balance of the membership to the new owner just to add to the feeling of security.
For more information on the Mock Audit™, or to schedule one for your pharmacy, contact CAPS at (855) 792-8347.