Do all pharmacies need to be accredited?
If your pharmacy bills Medicare Part B for DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) which includes diabetic supplies, then the pharmacy must be accredited in order to continue billing Medicare Part B for such supplies and to retain their Medicare Part B supplier billing number.
Which pharmacies need to be accredited in 2007?
CMS has instructed the approved accreditation organizations to begin accrediting those pharmacies in the first 10 Metropolitan Statistical Areas (MSAs) selected by CMS and to be announced in Jan 2007. For those suppliers located in these MSAs and participating in the competitive acquisition program, accreditation will need to be accomplished by Spring 2007 (actual date to be determined).
If my pharmacy is not located in the first 10 MSAs, then when will I need to be accredited?
CMS will select 80 MSAs in 2008. All DMEPOS suppliers and those not participating in the competitive acquisition program will need to be accredited by 2010.
COMPETITIVE ACQUISITION AUTHORITY
Section 302 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) (Pub. L. 108-173) authorizes the Secretary to utilize our competitive acquisition authority, as outlined in the U.S. Code Section 1847(a). Section 302(b)(1) of the Medicare Modernization Act, requires Medicare to replace the current durable medical equipment (DME) payment methodology for certain items with a competitive acquisition process to improve the effectiveness of its methodology for setting DME payment amounts. This new bidding process will establish payment amounts for certain durable medical equipment, enteral nutrition, and off-the-shelf orthotics. Competitive bidding provides a way to harness marketplace dynamics to create incentives for suppliers to provide quality items and services in an efficient manner and at reasonable cost. The Medicare DME Competitive Bidding Program has five objectives:
To operationalize competitive bidding for DME and to use this to determine appropriate prices for categories of DME covered by Medicare Part B
To protect beneficiary access to quality DME throughout the program
To reduce the amount Medicare pays for DMEPOS and bring the reimbursement amount more in line with that of a competitive market
To limit the burden on beneficiaries by reducing their out-of-pocket expenses
To mitigate proliferation of use of certain items of DMEPOS by contracting with suppliers who engage in a business model that is beneficial for the program and for Medicare beneficiaries. In the coming months CMS will be publishing more information and resources related to this provision.