New Duplicate Discount Audit Trends
Over the course of 75 audits and several on-site visits in the past year, the Macro Helix Audit Support Team has seen that HRSA auditors are now routinely asking for UB04's from Parent and all Child sites.
This is in addition to the sample provided during an audit.
We see this as a part of a broader focus to prevent duplicate discounts across 340B programs. Along with HRSA audits there is an increased number of manufacturer and Kalderos inquiries.
Auditors will be looking to make sure that the NPI on the UB04 matches the Medicaid Exclusion File exactly.
Also, if your state requires a modifier it must be present on the bill. Not having the correct NPI and modifier can result in a duplicate discount finding.
As a part of your self-audit practices consider pulling a few random UB04's each time and checking the NPI and any required modifiers.
Your Audit Support Team at Macro Helix has the experience and resources to keep you pro-active and prepared for all of these inquiries.
As a part of your self-audit practices consider pulling a few random UB04's each time and checking the NPI and any required modifiers.