HMOs other Third-Party Players May Inadvertently Decrease or Deny Reimbursement by: David
DAW 1 may be assigned by a physician - but DAW 5 or 8 may not be.
Drug availability is not controlled by the prescription writer.
Thus DAW 5 or 8 may be assigned just before or at the time of dispensing the medication.
Usually, the order entry pharmacy technician enters the DAW code into the pharmacy's computer software program.
As the pharmacist has the final check on the prescription, he or she is responsible for reviewing the prescription data that is entered to make sure it was imputed correctly.
If the wrong DAW code is entered, third-party reimbursements may hang in the balance. The major players, including third-party prescription organizations and HMOs (Health Management Organizations), have departments and supercomputers which mine the prescription data from every prescription that is entered is submitted for reimbursement payment.
If there is an inputting error from a pharmacy tech or pharmacist, which results in a lower reimbursement or an outright denial of reimbursement, the pharmacy will lose out on that insurance money.
Incorrectly reimbursed prescriptions or flat out denials hit pharmacies at their bottom line. Most pharmacies, whether hospital, chain, independent, or other types(s), are usually in business to make a profit.
Insurance and Third-Party Auditors routinely travel to pharmacies and go through the physical and digital records of their insured customers. It happens more than people realize it does. If the proper documentation is not indicated on those paper and digital records, as I stated earlier, partial or total reimbursement denials are very likely.
Patient is prescribed 10g of Glucose. The glucose is presented as a 5% solution in 500ml Saline. How much of the 5% dextrose saline solution do you need