Medicare

Medicare Compliance for Refills

Are you Billing Medicare Part B for Blood Glucose Testing Supplies and other items that are refilled on a recurring basis? If you are, Medicare has some new rules and clarified some older ones. These apply to ALL suppliers, whether accredited or not. Pharmacies are required to contact the beneficiary or designee regarding refills. This must take place no sooner than 14 calendar days prior to the refill due date and you  may not dispense the item to the beneficiary…

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Medicare Audits Are On the Rise

In 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…

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NSC Site Visit vs. Accreditation Survey

Do you know the difference between an NSC Site Visit and an Accreditation Survey? As a Medicare Part B Supplier you will go through periodic onsite surveys by the National Supplier Clearinghouse and your Accreditation Organization. These two types of surveys are separate and distinct from one another and not allowing either to take place could have negative effects on your ability to bill Medicare. Confused? No worries, many Medicare Part B Suppliers are because they have so many different surveyors coming in to…

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Seven Necessities for Fraud, Waste, and Abuse Compliance

Every company wants to operate free from fraud, waste, and abuse (FWA). It’s good for business. So, try to think of that as the silver lining to the fact that your pharmacy is required by CMS, and many states, to have a formal fraud, waste, and abuse compliance program. The Affordable Care Act spelled out seven elements you need in your fraud, waste, and abuse program: Written policies, procedures, and standards of conduct A designated compliance officer and compliance committee,…

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