How Pharmacies Can Prepare for LTC at Home Audits

Long-Term Care (LTC) at home services are growing rapidly, providing a vital solution for patients who require medication management but prefer to remain in their own homes. However, with this expansion comes increased oversight from payers and regulatory bodies. Pharmacies offering LTC at home services must be audit-ready at all times to ensure compliance and avoid reimbursement issues.

In this guide, we’ll walk through the key steps to prepare for an LTC at home audit, covering policies, procedures, specialized packaging, patient attestations, and billing best practices.

📌 Step 1: Establish & Maintain Clear Policies and Procedures

Auditors will want to see documented policies and procedures demonstrating that your pharmacy operates in compliance with LTC at home requirements.

✔ Define LTC at Home Services – Clearly outline what qualifies a patient for LTC at home services and how your pharmacy supports them. ✔ Medication Management Policies – Document adherence packaging options, delivery protocols, and patient counseling requirements. ✔ Delivery & Logistics Processes – Detail how medications are safely delivered, including timeframes, handling procedures, and tracking. ✔ 24/7 Pharmacy Access – Ensure policies reflect that patients have access to a pharmacist at least four days a week, as required by LTC at home standards. ✔ Compliance with State & Federal Regulations – Ensure policies align with CMS guidelines and state pharmacy board requirements.

💡 Pro Tip: Have your policies reviewed annually to stay up to date with any regulation or payer changes.

📌 Step 2: Ensure Specialized Packaging & Delivery Compliance

One of the key differentiators between an LTC pharmacy and a retail pharmacy is the ability to provide specialized packaging and customized medication delivery.

✔ Adherence Packaging is Expected – LTC at home patients typically require multi-dose packaging, such as blister packs or compliance pouches, to ensure medication adherence. ✔ Documentation of Packaging & Delivery – Maintain logs showing patient preferences, adherence compliance, and proof of delivery for all LTC patients. ✔ Capacity Requirements – While CMS does not explicitly mandate specialized packaging, many payer contracts require it. Ensure your pharmacy has the infrastructure to support these services.

💡 Pro Tip: If your pharmacy is not providing specialized packaging, it should not classify a patient as LTC at home to avoid compliance risks.

📌 Step 3: Implement Patient Attestation & Eligibility Verification

To qualify for LTC at home services, patients must demonstrate a need for specialized pharmacy support. Auditors will look for proof that your pharmacy verifies this eligibility regularly.

✔ Patient Attestation Forms – Require patients (or caregivers) to sign an attestation form stating they need LTC-level pharmacy services. ✔ Update Every Six Months – Attestation forms should be updated at least twice per year to reflect the patient’s ongoing need for LTC pharmacy services. ✔ Secure Documentation – Store signed attestation forms in an easily accessible electronic health record system or within your pharmacy management software.

💡 Pro Tip: Implement a workflow reminder in your system to alert staff when a patient’s attestation form is due for renewal.

📌 Step 4: Understand Billing & Documentation Best Practices

Billing errors are one of the most common causes of audit failures. Pharmacies must properly document and classify LTC at home patients to ensure they meet payer requirements.

✔ Differentiate LTC at Home vs. Facility-Based Patients – Use the correct pharmacy services type in your system to distinguish between LTC at home and facility-based patients. ✔ Verify Payer Requirements – Some payers require specific NPI numbers or separate LTC contracts. Ensure your pharmacy’s enrollment and claims processing align with payer expectations. ✔ Maintain Consistent Records – Keep detailed documentation of medication orders, delivery confirmations, and patient eligibility to support your claims.

💡 Pro Tip: Regularly audit your own billing codes and documentation to catch potential errors before an external audit occurs.

📌 Step 5: Train Your Team on Audit Readiness

Even the best policies won’t help if your staff is unprepared for an audit. Training your team ensures everyone knows what to expect and can confidently provide auditors with necessary documentation.

✔ Educate on Compliance Expectations – Train pharmacists and technicians on LTC at home service requirements, documentation, and billing protocols. ✔ Conduct Internal Mock Audits – Periodically run an internal review to ensure that records, attestations, and packaging requirements are up to date. ✔ Have a Clear Process for Audit Requests – Designate a point person to handle audit requests and ensure timely responses with only the required information.

💡 Pro Tip: Keep an audit checklist accessible for quick reference when an audit request comes in.

📌 Final Thoughts: Be Proactive, Not Reactive

The best way to pass an LTC at home audit is to always be audit-ready. Pharmacies should establish clear policies, implement specialized packaging, track patient attestations, and maintain accurate billing records. Regular staff training and internal compliance checks can help prevent issues before they arise.

Be Proactive, Not Reactive! Staying ahead of compliance requirements ensures a smooth and successful audit process while reinforcing your pharmacy’s commitment to quality care.

Ready to Take Your LTC at Home Services to the Next Level?

Join the LTC@H Pharmacy Network today and gain exclusive access to essential resources designed to help your pharmacy succeed in LTC at home services.

🔹 Comprehensive Policies & Procedures – Stay audit-ready with proven compliance guidelines. 🔹 Best Practices for Delivery & Medication Packaging – Ensure your pharmacy meets payer and patient expectations. 🔹 Audit Preparation Checklists & Templates – Simplify compliance with step-by-step resources. 🔹 Industry Insights & Networking – Connect with other LTC pharmacies and stay ahead of regulatory changes.

🚀 Don’t wait until an audit happens—be prepared today!

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