1. Agree on the scope
Choose the clinic, product, service dates and review cutoff. Identify who owns purchase, pharmacy, treatment, authorization, claim and payment records. Record which exports are missing before interpreting a result.
2. Keep supply channels separate
Clinic-purchased stock and patient-specific pharmacy supply represent different economic relationships. Use receipts and returns for stock. Use shipment and treatment evidence for pharmacy-supplied medication. Do not treat a pharmacy shipment as a clinic purchase.
3. Preserve product and unit identity
A package, a milligram and a billing unit are different quantities. Keep the product, package identifier, labeled strength and source units. Check the CMS code for the treatment date. Similar ingredients or shared billing codes do not establish interchangeable products.
4. Link evidence before judging exceptions
Connect supplied treatment records to authorization, claim and remittance evidence. Keep reversals, replacements and adjustments visible. Separate a missing export from a confirmed discrepancy; a missing payment record alone does not establish a loss.
5. Assign the next action
Each exception needs the source references, a concise explanation, an owner and the record or clarification needed next. Have a responsible reviewer confirm the evidence before communicating a conclusion to a clinic.
6. Save the review and measure the work
Archive the reviewed state and source/rule context. Measure time spent obtaining records, reviewing and resolving questions. On the next refresh, compare what changed and reuse approved mappings. Count verified resolutions separately from estimated opportunity.
Reference: CMS quarterly HCPCS files. Use the release applicable to the service date. This is an operational checklist, not a payer or clinical determination.