APhA Policy Manual

Audits of Health Care Practices

PHARMACY PRACTICE PHARMACY TECHNICIANS QUALITY ASSURANCE REIMBURSEMENT AND COMPENSATION

APhA recognizes that audits of health care practices, when used appropriately, may improve patient care and deter fraud, waste, and abuse.
APhA advocates for the use of standardized and efficient audit procedures with transparent criteria clearly communicated by the payor and readily accessible to providers in advance.
APhA advocates that audit processes should result in minimal disruption to practice workflow, minimal financial burden, and no impact on patient care.
APhA urges timely notification and scheduling of claims audits to minimize disruption of patient care delivery.
APhA supports the inclusion of education as a component of the audit process to improve documentation of services, meet payor requirements, and enhance the quality-of-care delivery.
APhA opposes incentive-based auditor compensation and the use of statistical methodologies, such as sample extrapolation, for determining the recoupment of funds from health care providers or health care organizations.
APhA advocates that audit reports include complete information listing audit discrepancies and appropriate guidelines for documenting and appealing these findings.
APhA advocates that pharmacy audits be performed in a professional manner by a pharmacist or certified pharmacy technician.