Monthly Archives : January 2012

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Pharmacy News: How important is DME Accreditation?

yes-no-buttonsHow important is DME Accreditation to independent pharmacy owners?

It’s hard to believe, but it’s already time for renew your DME Accreditation. It may seem a bit early, but per CMS, your Accrediting Organization needs your application around six months prior to your expiration date to ensure you can be surveyed prior to the expiration of your current accreditation.

You may be asking yourself, should I stay accredited?

The answer is – Harry Lattnazio | yes-word1

Why? Well, there are three interrelated factors to consider.

Let’s go over them now:

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No matter how long you have owned your pharmacy and how successful you have been, you know what is going on in the industry – drug reimbursements are going down. In most cases this is not true for DME, they continue to have a higher profit rate than drugs.

Another item I am sure you are becoming more keenly aware of lately is the number of Medicare audits that are occurring across the country, clawing back billions of dollars annually from providers and suppliers. These audits are made easier when your pharmacy is accredited. And Accreditation provides you with a solid intake process that will help you and your employees better understand and comply with the Medicare Documentation Requirements and the Supplier standards.

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Pharmacists have been one of the top respected professions for decades. This puts us in a unique position to care for our patients across the health spectrum, from drugs, DME and even education.

One of the areas that pharmacies have not taken advantage of in the past when it comes to DME, is the potential for cash and add-on opportunities to increase the patients quality of life, especially with your basic Mobility patients (including walker, canes, crutches and wheelchair patients). In many cases, these patients or their caregivers do not know what kind of items are available to them to make their lives simpler and more importantly safer.

Future

No one is sure what will happen in the future, the exemption could go away.

But what we do know, several insurers, both private and state funded, have been in the process of requiring accreditation for DME.

Some of the insurers doing this recently have been:

  • Security Blue (Pennsylvania)
  • Maryland Medicaid
  • Anthem
  • two New Jersey Medicaid HMOs.

This will begin happening more and more, and we could see even our diabetic patients being pulled from us to get their testing supplies from an accredited pharmacy. Will they take their prescriptions with them?

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Pharmacy News: Medicare Audits Are On the Rise

clawbackIn recent Medicare Audits, over 80% of glucose testing supplies and nearly 70% of nebulizer and nebulizer solutions claims were denied.  This resulted in BILLIONS of dollars being recouped from Medicare Suppliers and providers.

As a Pharmacy Owner, are you prepared if an Auditor comes to your door?

When working with clients, I let them know there are several things that they can do in their pharmacy help prevent the clawback of  hard earned revenue.

  • Be sure you are in Compliance with all 30 Medicare Supplier Standards, whether you are Accredited or not.
  • Understand your DME-MAC’s LCDs (Local Coverage Determinations)
  • Have a Checklist available of all information that is required in a patient’s file.
  • Perform internal audits and quality assurance checks to ensure all of your patient files have the proper information included in them.
  • Have an open relationship with dispensing physicians so you can easily obtain needed information before sending your claims to Medicare.
  • Keep an eye on your mail, most audits will be a request for documentation sent to you by a Medicare Contractor and give typically 30 days to respond.  If you don’t reply, you will have lost your monies.
  • MOST IMPORTANTLY — Keep your staff trained and up to date on all requirements!

Make these practices part of your daily routine and you will be ready when that Medicare Auditor comes knocking.