Pharmacy Data Management
The pharmacy data management services that we offer have been improved upon and refined over the last 7 years to make them the most comprehensive solutions in the industry. Our data management experience stems from a wide variety of managed care and government sponsored pharmacy claim processing projects.
The data management and audit staff at IPS is fully capable of reviewing all aspects of prescription drug benefits, provider performance as well as regulatory compliance. IPS has been approved as a CMS Medicare auditor and has participated in the planning and training of the CMS requirements.
IPS pharmacy claims auditors are pharmacists and certified pharmacy technicians fully trained and skilled in identifying inappropriate, potentially fraudulent and deficient billing practices. Many of our data management and audit projects have been customized to meet our client’s needs and can function in an educational mode demonstrating that our services can be tailored toward behavior modification and quality assurance rather than just financial sanctions. Examples of our data management projects include:
- Network Pharmacy claims audit experience ranging from retail, long-term care, 340B and Medicare Part D pharmacy audits across the 48 contiguous states
- Pharmacy Benefit Management (PBM) audits
- Rebate Auditing
- Fraud, Waste, and Abuse Programs
- Drug utilization analysis and programs designed based on the results
- Drug disease management initiatives
- A self-insured health plan contracted with IPS to conduct and audit on the pharmacy claims process by their PBM. The audit reviewed up to date pricing, accurate dispensing fees, application of co-payment, compound prescription pricing, and other criteria. IPS evaluated the claims and reported all discrepancies as well as made recommendations for reclaim.
- A pharmacy data management firm contacted IPS to conduct an audit on manufactures rebates on behalf of a client. IPS identified inconsistencies in rebate payment practices in our audit findings and provided recommendations for reclaim.
- After a reported controlled substance loss, a hospital contacted IPS to perform routine site inspections, audits and review of all aspects of pharmacy services related to controlled substance management, delivery, administration, record keeping and disposition.
- A nursing home contacted IPS after the Department of Public Health directed them to engage in an outside independent pharmacy service. IPS performed a full review of all patient profiles and medication orders to ensure accuracy, prepared a report of the findings and provided recommendations for correction.