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PTR Pharmacy Podcast Episode 26: Jeffrey Hedges - The HIPAA GUY - Medicare Audits & Independent Pharmacy

1.     Medicare Audits

a.     Diabetic Supplies (Strips & Lancets)

                                          i.    Must have Proof of Delivery

                                         ii.    Proof of Delivery must match the claim to Medicare and the EOB

                                        iii.    Patient Testing logs

                                        iv.    Patient acknowledgment that they received education and demonstrated proper equipment usage

                                         v.    Physician notes

                                        vi.    If patient did not sign for the product, the patient representative must state why and provide name, address and relationship to patient


b.    Respiratory (O2 & CPAPs)

                                          i.    Respiratory Therapist must be sign off on all respiratory products

                                         ii.    O2, Pulse Ox

                                        iii.    CMN signed by physician before claim is submitted to CMS


2.     Medicare Accreditation

a.     Accreditation Organizations will be checking the following:

                                          i.    Personnel Folders

1.     Training accomplished

2.     Hep B vaccine or declination

3.     Employee Evaluations

4.     Signed Job Descriptions

5.     Valid licenses and certifications

                                         ii.    Patient Folders

1.     Proof of Delivery

2.     Prescription

3.     CMN or Detailed Written Order (if required)

4.     Proof of warranty & education

5.     Assignment of Benefits

6.     Collection of the 20% of Medicare allowable with evidence of collection (reconciliation)

                                        iii.    Performance Management

1.     Patient Satisfaction Surveys

2.     Patient complaints

3.     Adverse Events




R. Jeffrey Hedges



R.J. Hedges & Associates

P.O. Box H

New Florence, PA  15944


Office:  724-357-8380 

Fax:      814-446-6336