Audit risk is insurance recouping the claim because it wasn't filled for a correct diagnosis. This is why we have to document an ICD 10 code on these orders, otherwise we can't prove it's for diabetes and the claim is pulled. Some insurance companies only allow us to bill for 30 days so what am I supposed to do when the dr writes for a box that lasts 56 days? I can break the box and dispense fewer pens but I'll never dispense the other pens so I'm stuck with $800 of inventory I can't move.
Insurance will only pay us AWP minus a certain percentage. It's all predetermined via third party contracts so I have to find the drugs at the cheapest possible price. What happens if the cheapest I can find is $1000 but they only pay $750 because that's the lowest price they can find on the secondary market? I'm out $250. You're not allowed to ask the insurance where they got the $750 figure from. It's proprietary information.