Pharmacies and Medicare Part B

Pharmacies need to be looking at some of their options for becoming a Medicare Part B Provider/Supplier as a large part of the United States population are becoming Medicare Beneficiaries.  This blog will discuss four practice areas payable by Medicare Part B that Pharmacies need to consider to diversify and increase profits.  These areas are: Drugs and Biologics (Application: CMS-855S or PECOS) DMEPOS (Application: CMS-855S or PECOS) Immunization (Application: CMS-855B or PECOS) Point of Care Testing (Application: CMS-855B or PECOS)…

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Pharmacy Can Now Temporarily Enroll as an Independent Clinical Diagnostic Laboratory with Medicare

  Attention CLIA Certified Pharmacies: Over ten thousand Pharmacies have a CLIA Certificate of Waiver.  Most of these Pharmacies have been providing CLIA waived testing as a cash service only, increasing revenue and helping to offset dropping reimbursements and DIRS. But earlier this month,  CMS issued an MLN Matters Article allowing Pharmacies with CLIA Certification already enrolled in Medicare to fast-track a temporary enrollment as an independent clinical diagnostic laboratory to help combat the spread of COVID-19 during the public…

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COVID-19 and Pharmacy

COVID-19.  We all know what it is by now – no need to explain further.  For specific information about COVID-19 from the experts, please visit the CDC website, Coronavirus Disease 2019 (COVID-19). In this blog, we will cover regulations and actions your Pharmacy can take to help your staff, patients, and community stay healthy.  We will also share links to various websites with relevant information for Pharmacy. COVID-19 and HIPAA For the most part, the HIPAA Rules remain the same,…

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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 clarifications for some older ones. These apply to ALL suppliers, whether accredited or not. Contact between the Supplier and Beneficiary The new Medicare compliance for refills mandates that pharmacies are required to contact the beneficiary or designee regarding refills prior to providing the refills and must not automatically dispense the…

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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. Purpose of Medicare Audits & What to Expect Before you start preparing for a Medicare audit, it’s important to understand its primary rationale so you clearly know what to expect. When an auditor pays you a visit, keep in mind that they have a two-fold purpose: checking that your…

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