Checklist template

Cash and third-party reconciliation for pharmacies

A ready-to-use checklist with 101 items in 6 sections, covering Tills, Co-pays, Claim rejections, Reconciliation, Deposits, Reports. Use it as-is in Bindy, or adapt it to your own standards in minutes.

  • 6 Sections
  • 101 Items
  • 84 Yes / No checks
  • 6 Scored ratings
  • 114 Points

Use this template How audits work

1. Tills 19 items

  1. Each pharmacy register starts the day with the float set by company policy Yes / No 1 pt
  2. Float counted in the pharmacy register checked during the visit (dollars) Number
  3. The counted float matched the float on record Yes / No 1 pt
  4. Each cashier at the pharmacy signs in to the register under their own number Yes / No 1 pt
  5. No pharmacy register was found signed in under an absent employee's number Yes / No 1 pt
  6. Pharmacy technicians do not share a cash drawer during a shift, or the sharing is recorded as company policy requires Yes / No 1 pt
  7. The cash drawer is closed between transactions Yes / No 1 pt
  8. Cash above the drawer limit is dropped into the safe with a recorded pickup Yes / No 1 pt
  9. Till counts at the end of the shift are done away from the pharmacy counter Yes / No 1 pt
  10. A second person verifies each till count Yes / No 1 pt
  11. Over and short amounts are recorded by cashier for each shift Yes / No 1 pt
  12. Shortages above the limit set by company policy were explained in writing in the last 30 days Yes / No 1 pt
  13. The drive-thru register is counted separately from the counter registers Yes / No 1 pt
  14. No-sale drawer openings at the pharmacy registers are reviewed weekly Yes / No 1 pt
  15. Voided pharmacy transactions carry a pharmacist's or manager's approval Yes / No 1 pt
  16. Refunds of prescription co-pays require the prescription to be reversed in the dispensing system Yes / No 1 pt
  17. Counterfeit detection pens or a detector are available at the pharmacy register Yes / No 1 pt
  18. Pharmacy till shortages recorded in the last 30 days Number
  19. Till control at the pharmacy registers Rating
    • Individual drawers, counted and verified 5 pts
    • Counted but shared or unverified 3 pts
    • Not counted by shift 1 pt

2. Co-pays 17 items

  1. The co-pay collected at the register comes from the scanned prescription receipt, not from a typed amount Yes / No 1 pt
  2. The register blocks the sale of a prescription that is not marked as verified in the dispensing system Yes / No 1 pt
  3. Each prescription bag is scanned at the register, so that sold status returns to the dispensing system Yes / No 1 pt
  4. Prescription sales sampled by the auditor from yesterday Number
  5. Sampled sales where the amount collected differed from the adjudicated co-pay Number
  6. Price overrides on prescription sales require a pharmacist's approval Yes / No 1 pt
  7. The price override report for prescriptions is reviewed weekly Yes / No 1 pt
  8. Co-pay waivers or discounts are given only under a documented company or manufacturer program Yes / No 1 pt
  9. Manufacturer co-pay cards are processed as a secondary claim, not as a cash discount at the register Yes / No 1 pt
  10. Employee prescriptions are rung by another employee Yes / No 1 pt
  11. Employee discount on prescriptions is applied by the system, not keyed by hand Yes / No 1 pt
  12. Prescriptions delivered to the patient's home have payment recorded before they leave the store Yes / No 1 pt
  13. Delivery drivers hand in co-pays collected with a signed delivery sheet Yes / No 1 pt
  14. House-charge or facility accounts are billed only for patients set up on an approved account Yes / No 1 pt
  15. No front store item was rung under the prescription department key on the receipts sampled Yes / No 1 pt
  16. Co-pays for prescriptions paid in the front store are identified as pharmacy sales on the receipt Yes / No 1 pt
  17. Collection of co-pays on the sample Rating
    • Every sale matched the adjudicated amount 5 pts
    • A few differences, explained 3 pts
    • Unexplained differences or overrides 1 pt

3. Claim rejections 16 items

  1. The rejected claims queue is worked every business day Yes / No 1 pt
  2. Rejected claims in the queue older than 7 days Number
  3. No prescription is released to the patient while its claim is rejected, unless the patient pays cash or a pharmacist approves Yes / No 1 pt
  4. Prescriptions released on a pending claim are tracked on a list until the claim is paid Yes / No 1 pt
  5. Refill-too-soon rejections are not overridden without the reason recorded Yes / No 1 pt
  6. Prior authorization requests are sent to the prescriber on the day of the rejection Yes / No 1 pt
  7. Prior authorization requests are followed up within the time set by company policy Yes / No 1 pt
  8. The prescriber billed is the prescriber named on the prescription, on the prescriptions sampled Yes / No 1 pt
  9. The days supply billed matches the quantity and directions on the prescriptions sampled Yes / No 1 pt
  10. The dispense-as-written code billed matches what the prescriber wrote on the prescriptions sampled Yes / No 1 pt
  11. The quantity billed equals the quantity dispensed on the prescriptions sampled Yes / No 1 pt
  12. The package size billed is the package size dispensed for unbreakable packs (inhalers, insulin pens, eye drops) Yes / No 1 pt
  13. On the profiles sampled with two plans, the primary plan was billed before the secondary plan Yes / No 1 pt
  14. Claims rejected after the patient left are resubmitted or collected from the patient Yes / No 1 pt
  15. Each plan's help desk number is available at the billing workstation Yes / No 1 pt
  16. Handling of rejected claims Rating
    • Queue cleared daily 5 pts
    • Queue has items older than a week 3 pts
    • Queue not worked 1 pt

4. Reconciliation 17 items

  1. Third-party payments received are matched to claims at the store or by head office, with exceptions sent to the store Yes / No 1 pt
  2. The store works its unpaid and partially paid claims list at the frequency set by company policy Yes / No 1 pt
  3. Unpaid claims on the store's list older than 60 days Number
  4. Each unpaid claim on the list has a note of the last action taken Yes / No 1 pt
  5. Claims paid at less than the adjudicated amount are queried with the plan Yes / No 1 pt
  6. Prescriptions filled and never picked up are reversed within the time allowed by the plans Yes / No 1 pt
  7. No billed prescription older than the plans' reversal limit was found in the will-call bins Yes / No 1 pt
  8. Billed prescriptions found in will-call past the reversal limit Number
  9. Pharmacy sales recorded at the register for yesterday agree with the dispensing system's sold report Yes / No 1 pt
  10. Differences between the register and the dispensing system are investigated on the next business day Yes / No 1 pt
  11. Prescriptions marked sold in the dispensing system with no register transaction are listed and explained Yes / No 1 pt
  12. Receivables from long-term care or facility accounts are invoiced monthly Yes / No 1 pt
  13. Facility accounts overdue beyond the term set by company policy are escalated Yes / No 1 pt
  14. Insurer audit requests received in the last 12 months were answered by the deadline Yes / No 1 pt
  15. Amounts recovered by insurers after audit in the last 12 months are recorded with the cause Yes / No 1 pt
  16. Signature logs or electronic pickup records are kept as proof of delivery for billed prescriptions Yes / No 1 pt
  17. Reconciliation of third-party claims Rating
    • Current, with exceptions followed up 5 pts
    • Behind, with unexplained balances 3 pts
    • Unpaid claims not followed up 1 pt

5. Deposits 16 items

  1. The pharmacy's cash is included in the store deposit with its own count sheet Yes / No 1 pt
  2. The deposit is prepared by one person and verified by a second Yes / No 1 pt
  3. Deposits are made on every banking day, or picked up by the armored carrier on schedule Yes / No 1 pt
  4. Deposit bags are sealed and numbered Yes / No 1 pt
  5. The bag number is recorded in the deposit log Yes / No 1 pt
  6. The armored carrier's employee signs for each bag Yes / No 1 pt
  7. Deposit slips validated by the bank are matched to the deposit log Yes / No 1 pt
  8. Bank adjustments to deposits in the last 30 days were explained Yes / No 1 pt
  9. Deposits are stored in the safe until pickup Yes / No 1 pt
  10. The safe is counted at each change of manager Yes / No 1 pt
  11. Checks received for co-pays or facility accounts are stamped for deposit when received Yes / No 1 pt
  12. Checks are listed individually on the deposit Yes / No 1 pt
  13. Payments received by mail for account customers are opened by two employees or logged on receipt Yes / No 1 pt
  14. Card settlement totals for the pharmacy terminals agree with the register report for the days sampled Yes / No 1 pt
  15. Days sampled for card settlement Number
  16. Deposit preparation and banking Rating
    • Dual control and banked on time 5 pts
    • Banked on time without dual control 3 pts
    • Late or unverified deposits 1 pt

6. Reports 16 items

  1. The daily pharmacy sales report is signed by the pharmacy manager or the store manager Yes / No 1 pt
  2. The cash over and short report by cashier is reviewed weekly Yes / No 1 pt
  3. The prescription reversal report is reviewed for reversals made after the sale Yes / No 1 pt
  4. The cash prescription report is reviewed for prescriptions changed from insurance to cash after filling Yes / No 1 pt
  5. The report of prescriptions with a zero co-pay override is reviewed weekly Yes / No 1 pt
  6. The refund report for the pharmacy registers is reviewed weekly Yes / No 1 pt
  7. The usual and customary price overrides report is reviewed by the pharmacy manager Yes / No 1 pt
  8. Exception reports reviewed carry the reviewer's initials and the date Yes / No 1 pt
  9. Exceptions involving the reviewer's own transactions are reviewed by another manager Yes / No 1 pt
  10. Reports are kept at the store for the period set by company policy Yes / No 1 pt
  11. The district or pharmacy supervisor reviews the store's reconciliation status at each visit Yes / No 1 pt
  12. Date of the last supervisor review of reconciliation Date
  13. Corrective actions from the previous review have been completed Yes / No 1 pt
  14. Name of the person responsible for pharmacy reconciliation Short text
  15. Overall control of pharmacy cash and third-party receivables Rating
    • Tills, deposits and claims reconciled and reviewed 5 pts
    • Reconciled with late or unexplained items 3 pts
    • Shortages or unpaid claims not followed up 1 pt
  16. Corrective actions required Comments

About this template

This checklist is part of the Bindy template library. Yes / No checks score 1 point when met; ratings score the points shown for each option. The overall score is the percentage of points earned, with N/A answers excluded. In Bindy you can add photos, assign corrective actions, require sign-off and compare results across sites.

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