Pharmacy News: The Affordable Care Act

health-care-reformThe Affordable Care Act and What It Means for Your Exemption from DMEPOS Accreditation.

The Supreme Court ruled 5–4 in favor of the constitutionality of the Affordable Care Act.  While there is much I could say about the entire law, I am not here to give my political views. Let me instead focus on what it all means for your pharmacy business.

As we know, and I have stated many times in past entries, the clause that allows many independent pharmacy owners to be exempt from DMEPOS Accreditation is a part of the Affordable Care Act.

Does Your Pharmacy Meet the Exemption Requirements?

First, if you are still questioning whether or not you qualify for an exemption from the current accreditation requirements and standards, it’s best to either seek legal counsel and/or contact Palmetto for information (their phone number is 866-238-9652). Be aware that you may be under a false assumption that you do qualify for the exemption. Please be sure for yourself before you count on this.

If You Meet the Requirements, What’s Next?

You are not automatically exempted. You are required to submit to National Supplier Clearinghouse a letter of attestation developed by the DME MACs. In this letter you attest that your pharmacy is exempt from the accreditation requirement because your total DMEPOS billings to Medicare have been less that 5 percent of your total pharmacy sales for the past three calendar or fiscal years and that your pharmacy has been a Medicare DMEPOS Supplier for over five years without any unrescinded adverse actions.

Regardless of whether your pharmacy qualifies for, files for; then, receives acceptance from the NSC for the exemption, you must, as always, comply with the Medicare DMEPOS Supplier Standards. So, having Policies and Procedures in place is very important. The supplier standards are published in CFR 42 424.57 (c).

business-decisionDoes Taking the Exemption Make Good Business Sense?

Please remember, many private, third-party insurance companies do require that suppliers obtain accreditation in order to bill for DME products. Also, many state Medicaid programs require accreditation for DME suppliers, and it’s not clear at this point if they will follow suit with any exemptions.

You may want to ask yourself, especially since you have already gone through the accreditation process, if you should keep your accreditation. With accreditation, you are sure to be compliant with all of the Supplier Standards, and you will meet any requirements that private, third-parties or Medicaid programs have.

There are also networks and buying groups out there who cater to accredited pharmacies. They offer enrollment to insurance plans that may be closed to  you if you are not accredited.

Weighing all of your options can be confusing at first, but there are resources to help—National Supplier Clearinghouse, CMS, and consultants can work with you to reach the right accreditation decision for your pharmacy.