As healthcare organizations look to rebate programs to offset tightening margins, audit readiness is becoming a strategic necessity.
Increased scrutiny from manufacturers and evolving requirements around documentation, PHI use, and clinical coding are shifting rebate submissions from “nice-to-have” to regulated deliverables.
Common Audit Pitfalls
- Incomplete or misaligned NDC/HCPCS mapping
- Lack of sourcing documentation, especially for physician-administered drugs
- Submitting PHI when not necessary—or failing to submit minimum required elements
- Using a one-size-fits-all model across different rebate programs
What an Audit-Ready Program Looks Like
- Traceable, clean claims with supporting encounter-level data
- Documentation protocols tailored to manufacturer expectations
- Policy alignment that ensures only eligible, verified claims are submitted
- De-identification practices that respect HIPAA minimum necessary standards
How VativoRx Supports Clients
- We design rebate programs that balance:
- Compliant claim documentation
- Automation that scales
- Minimal burden on provider or health plan teams
If you’re unsure whether your program can stand up to audit scrutiny, we can help you get there.
Contact us to schedule a rebate review or learn how to strengthen your audit trail.
